Iatrogenic Type A Aortic Dissection: A Narrative Review Of Endovascular And Surgical Management Strategies And Outcomes

Abstract

Iatrogenic Type A aortic dissection (iTAAD) is a fatal but infrequent complication of or following cardiac and endovascular interventions. With advancing interventional and surgical cardiovascular technology, paradoxically, iTAAD incidence has risen, prompting a reassessment of current diagnostic, therapeutic, and prevention concepts. This narrative Review strives to integrate recent evidence of surgical and endovascular repair of iTAAD, summarize trends in outcomes, and enumerate the most important innovations that have impacted clinical practice. Indexed journals and contemporary clinical evidence (2021-2025) were systematically searched. Six extremely relevant studies, including case reports, systematic reviews, and observational analysis, were selected for inclusion and analysis based on direct relevance to iTAAD pathophysiology, surgical treatment, and perioperative outcomes. Evidence suggests that while iTAAD remains treated mainly by open surgical repair, complete endovascular solutions are increasingly viable options in meticulously selected high-risk or delay-presenting patients. Success at operation is strongly associated with early detection, dissection anatomical extent, and institutional expertise. Comparative outcomes suggest increased mortality in iTAAD vis-a-vis spontaneous dissection but with the introduction of newer hybrid and branched stent technology. iTAAD management necessitates an update in a multidisciplinary approach based on early diagnosis and tailored treatment. While surgery remains the prevailing modality, endovascular innovation transforms the therapeutic landscape and challenges prevailing dogma. Prospective registries are required to validate optimal algorithms and improve patient survival.