The incidence of concomitant abdominal aortic aneurysm (AAA) combined with gastrointestinal malignancy is rare, but it still represents an issue of controversy regarding the optimal treatment. It is unclear whether to treat the AAA and gastrointestinal malignancy simultaneously or in a staged manner as both options offer advantages but also carry some substantial risks. This study attempts a historical review of the surgical practice during the past decades by reviewing the existing literatures on this topic. In general, the most symptomatic lesion or the most life threatening condition should be treated firstly. Large aneurysm should usually be resected in preference to gastrointestinal malignancy unless the tumor is locally advanced, perforated or likely to result in intestinal obstruction. If both lesions are complicated there may be a case for simultaneous treatment. The evolution of vascular stents and the reported efficacy of endovascular aortic repair (EVAR) provide an alternative method for treating high risk patients. If the anatomical criteria are satisfied, EVAR combined with laparoscopic operation could become the optimal solution for the concomitant AAA and gastrointestinal malignancy patients, especially those who require minimally invasive treatment.
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