The Surgical Management of an Abdominal Aortic Aneurysm Concomitant With a Renal Tumor Invading the Aortic Wall

An abdominal aortic aneurysm (AAA) concomitant with a malignant renal tumor (RMT) invading the aortic wall is an extremely rare and complex condition. The optimal surgical strategy, including procedure type and sequencing, remains unclear. We report the case of a 48-year-old male who presented to our hospital with general fatigue and significant weight loss and was found to have a 58 mm AAA along with a massive left renal tumor adjacent to the aortic wall. Multidisciplinary discussions were held between the cardiovascular surgery and urology teams. The patient underwent a two-stage surgical approach involving open AAA repair using a bifurcated graft, followed by open radical left nephroureterectomy. Histopathological analysis of the renal tumor confirmed urothelial carcinoma. The postoperative course was uneventful, and the patient was discharged nine days after the urological surgery (28 days after the aortic surgery). Two months later, a pulmonary metastasis was detected. Despite multiple lines of chemotherapy, the disease progressed gradually, and the patient died of respiratory impairment caused by rapidly progressive pulmonary metastases 11 months after the initial surgery. The short-term outcome in this patient was favorable; however, more sophisticated treatment strategies should be developed in the future based on further research.