Iatrogenic aortic dissection: Insights from the International Registry of Acute Aortic Dissection

Objectives: Risk factors, presentation, treatment, and outcomes were evaluated for iatrogenic aortic dissection (iAD) in comparison with spontaneous aortic dissection (sAD). Methods: Patients with acute aortic dissection (AD) enrolled in International Registry of Acute Aortic Dissection from 1996 to 2023 were separated into 2 groups: iAD (n = 333 [2.5% of total ADs]; type A: 252, type B: 81) and sAD (n = 13,122; type A: 8846, type B: 4276). Results: The etiology of iAD was predominantly cardiac surgery (n = 146; 51% type A, 32% type B) and catheter-induced (n = 134; 41% type A, 47% type B). Patients with iAD were more likely to be older, with a greater preponderance of atherosclerosis, known aortic aneurysm, valve disease, and peripheral arterial disease. Patients with type A iAD had smaller aortic size and less frequent aortic regurgitation, in addition to pericardial effusion. They also had less typical symptoms of AD. Medical management of type A AD was used more frequently in iatrogenic compared with spontaneous cases (13% vs 8%, P = .016); management was statistically similar for type B. Overall type A iAD had a greater hospital (25.8% vs 18.4%, P = .005) and 4-year mortality (P = .003), although mortality was similar for type B AD (P = not significant). In a multivariable model, there was no difference in type A hospital mortality between sAD and iAD. Conclusions: iAD occurs in older patients with known atherosclerosis and frequently without typical symptoms. Medical management is used more frequently for type A iAD. Mortality was greater for type A iAD compared with sAD; however, no differences were seen for type B or in overall mortality for type A in a multivariable model.