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

Abstract

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

Methods: Patients with acute AD enrolled in IRAD from 1996-2023 were separated into two 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 - 4,276).

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 higher preponderance of atherosclerosis, known aortic aneurysm, valve disease, and peripheral arterial disease. Type A iAD patients had smaller aortic size and less frequent aortic regurgitation, and pericardial effusion. They also had less typical symptoms of AD. Medical management of type A AD was utilized more frequently in iatrogenic compared to spontaneous cases (13% vs. 8%, p= 0.016); management was statistically similar for type B. Overall Type A iAD had a higher hospital (25.8% vs 18.4%, p=0.005) and 4-year mortality (p=0.003), though mortality was similar for type B AD (p= NS). 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 utilized more frequently for type A iAD. Mortality was higher for type A iAD compared to sAD, however no differences were seen for type B or in overall mortality in a multivariable model.