Abdominal aortic aneurysm and gastrointestinal disease: should synchronous surgery be considered?

Abdominal aortic aneurysm (AAA) is relatively common in an age group in which other abdominal pathologies have an increasing incidence. The co-existence of an aneurysm with a second intra-abdominal pathology presents a difficult management problem for the surgeon. Synchronous aortic and gastrointestinal surgery is often avoided due to the perceived higher risk of infection of the vascular prosthesis.

Cases of synchronous AAA repair with a second gastrointestinal/biliary procedure were identified from the operative records of a single vascular surgeon working in a district general hospital.

Eight cases were identified over a 10-year period, comprising 3 large bowel resections, 2 cholecystectomies and 3 upper gastrointestinal operations as the second synchronous procedure. No graft infections were recorded in this group and there was one death within 30 days.

From our experience and a review of the available literature we conclude that synchronous aortic and gastrointestinal surgery should be considered when urgent surgery for both conditions is indicated.