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

Abstract

Risk factors, presentation, treatment, and outcomes were evaluated for iatrogenic aortic dissection (iAD) in comparison with spontaneous aortic dissection (sAD). 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). 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. 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.