Role of conservative management in traumatic XXXX : comparison of long-term results of conservative, surgical, and endovascular treatment.

@entity1 @entity2333 @entity65 @entity130
OBJECTIVE: The purpose of this study is to compare early and long-term results in terms of survival and @entity65 of @entity1 with acute traumatic @entity130 who were conservatively managed with @entity1 who underwent surgical or endovascular repair. METHODS: From January 1980 to December 2009, 66 @entity1 with acute traumatic @entity130 were divided into 3 groups according to treatment intention at admission: 37 @entity1 in a conservative group, 22 @entity1 in a surgical group, and 7 @entity1 in an endovascular group. Groups were similar with regard to gender, age, Injury Severity Score, Revised @entity130 Score, and @entity130 Severity Score. RESULTS: In-hospital mortality was 21.6% in the conservative group, 22.7% in the surgical group, and 14.3% in the endovascular group (P = .57). In-hospital @entity2333 occurred only in the conservative group. Median follow-up time was 75 months (range, 5-327 months). Conservative group survival was 75.6% at 1 year, 72.3% at 5 years, and 66.7% at 10 years. Surgical group survival remained at 77.2% at 1, 5, and 10 years, whereas survival in the endovascular group was 85.7% at 1 and 5 years (P = .18). No @entity1 in the surgical or endovascular group required reintervention because of @entity2333 , whereas 37.9% of the conservative group had an aortic-related complication that required surgery or caused the @entity1 's death during the follow-up period. Cumulative survival free from @entity2333 in the conservative group was 93% at 1 year, 88.5% at 5 years, and 51.2% at 10 years. Cox regression confirmed the initial type of aortic lesion (hazard ratio, 2.94; P = .002) and a @entity130 Score-Injury Severity Score greater than 50% on admission (hazard ratio, 1.49; P = .042) as risk factors for the appearance of @entity2333 . Two peaks in the complication rate of the conservative group were detected in the first week and between the first and third months after blunt @entity130 . CONCLUSIONS: The advent of thoracic aortic endografting has enabled a revolution in the management of acute traumatic @entity130 in @entity1 with multisystem @entity130 with a low in-hospital morbimortality. Nonoperative management may be only a therapeutic option with acceptable survival in carefully selected @entity1 . The natural history of these @entity1 has revealed a marked trend of late @entity2333 developing, which may justify an endovascular repair even in some low-risk @entity1 .
