Synchronous abdominal aortic aneurysm and colorectal cancer. The therapeutic dilemma in the era of endovascular aortic aneurysm repair.

The incidence of synchronous abdominal aortic aneurysm (AAA) and colorectal cancer (CRC), although quite rare, still represents an issue of controversy regarding the optimal treatment. This study attempts a historical review of the surgical practice during the past decades by reviewing the existing English literature on this topic. The dilemma between one or two stage treatment has remained as both options offer advantages but also carry some substantial risks. The current practice gives priority to the life threatening disease (AAA>5.5 cm, symptomatic or complicated CRC) (two stage treatment) or suggest simultaneous management (one stage) when both diseases require urgent surgical treatment. The evolution of vascular endografts and the reported efficacy of endovascular aortic repair (EVAR) provide an alternative method for treating these high risk patients, by surpassing some significant obstacles. If the anatomical criteria are satisfied, EVAR could become the optimal solution for the concomitant AAA and CRC patients, especially those who require one stage treatment.