Rationale:Iatrogenic acute aortic dissection (IAAD) induced by cardiac surgery is a fatal complication, with 0.04% of therapeutic procedures and worse outcomes than spontaneous aortic dissection.Patients concerns:A 64-year-old male complaining of intermittent chest tightness for 4 years received an off-pump coronary artery bypass grifting (OPCABG) and IAAD was found during surgery.Diagnosis:Unstable angina, coronary artery triple vessel lesion, IAAD.Interventions:An ascending aorta replacement surgery was implemented immediately and extracorporeal membrane oxygenation (ECMO) was applied during surgery. The patient suffered from oliguria symptoms and began to receive continuous renal replacement therapy (CRRT) after surgery. What was worse, osteofascial compartment syndrome (OCS) was also confirmed the day after surgery.Outcomes:The CRRT and ECMO were both removed and the condition of the right leg was also stable. But the patient passed away because of uncontrollable sepsis 18 days after the surgery.Lessons:OPCABG is clearly the riskiest type of surgery associated with IAADs in cardiac surgical procedures, which should be considered with great concern. Whether ECMO should be used postoperatively in IAAD patients is still a controversial subject, due to some fatal complications linked with it.