Elsevier

Annals of Vascular Surgery

Volume 40, April 2017, Pages 295.e1-295.e4
Annals of Vascular Surgery

Case Report
Treatment of a Patient with Abdominal Aortic Aneurysm and Hepatocellular Carcinoma

https://doi.org/10.1016/j.avsg.2016.07.075Get rights and content

Background

The surgical tactics in cases of abdominal aortic aneurysms (AAA) and intra-abdominal malignancy are not uniform in the literature and are still a matter of debate. In this case report, we present a patient with coexisting AAA and primary liver cancer managed by simultaneous open AAA repair and liver resection After laparotomy and intraoperative liver ultrasonography that confirmed resectability of the tumor, aneurysm repair was performed with aorto-aortic tube grafting after interrenal cross-clamping Radiofrequency-assisted liver transection was performed to complete an anterior anatomic resection of liver segments VI and VII. The postoperative course was uneventful and the patient was discharged on a postoperative day 10.

Methods

This was prospective follow up of one patient.

Results

The patient is free from disease at 18-month follow-up.

Conclusions

The best treatment strategy for patients with AAA and malignant disease is still not clearly defined. Strategy selection is made individually according to the risk of rupture of AAA, general condition of the patient, experience of the teams that should perform the procedure and estimated life expectancy after resection of malignant disease.

Section snippets

Case Report

A 78-year-old man was admitted for the treatment of a 65-mm asymptomatic aneurysm of the abdominal aorta. An abdominal ultrasonography revealed a primary liver tumor located in the right liver lobe. An abdominal multidetector-computerized tomography (MDCT) demonstrated a 7 × 6 cm tumor occupying liver segment VI and VII having typical radiologic characteristics of hepatocellular carcinoma (HCC)—arterial enhancement and wash-out on portal phase. No extrahepatic spread was found on abdominal MDCT

Discussion

This case report deals with the successful treatment of a patient with AAA and HCC undergoing simultaneous open repair of the aneurysm and liver resection.

When 2 such life-threatening diseases coexist in the same patient, it is essential to study the operative indications for each disease and carefully plan an appropriate treatment strategy. For optimal plan, there are 3 main issues to address: the risk of aneurysmal rupture if the repair is delayed because of initial resection of the malignant

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The patient provided informed consent for this study.

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