Aortic dissection: The medical emergency linked to Lindsey Graham’s death

By Deidre McPhillips, CNN

(CNN) — US Sen. Lindsey Graham, a Republican from South Carolina, died on Saturday night from a tear in his artery, according to preliminary findings from a medical examiner.

Aortic dissection is rare, and life-threatening in most cases, experts say. The acute event happens quickly but there are steps you can take to lower your risk.

What is an aortic dissection?

The aorta is the largest blood vessel in body and the first place blood travels through as it’s pumped from the heart to other parts of the body.

An aortic dissection occurs when there is a tear in the aorta, which disrupts the critical source of blood flow.

Dr. Barbara Hamilton, an assistant professor of cardiac surgery with a specialty in aortic surgery at the University of Michigan, says the aorta is like an onion with many layers. A tear can happen on the inner layer of the aorta, which would create a “false passage” for blood, she said — letting it travel between the layers of the blood vessel instead of reaching important organs.

A dissection can also tear through all layers of the aorta at once, which “basically is like your heart exploding,” said ​Dr. John Trahanas, a cardiac surgeon and co-director of the Aortic Center at Vanderbilt.

An acute emergency

An aortic dissection typically happens suddenly, often without warning.

“It’s not something that is slowly progressing over time,” Hamilton said. “There isn’t this insidious, creeping, on-off chest pain that’s been lingering. When it hits, it’s usually a 10 out of 10 pain.”

It can seem a bit like a heart attack or stroke, experts say. Most often, there is chest pain that radiates to the back. It sometimes presents as leg pain or leg numbness, if the tear is preventing blood from traveling throughout the body more broadly.

About half of the people who have an aortic dissection will die before they’re able to receive any emergency care because it is such a sudden and severe event.

But for others, receiving care quickly is critical.

Emergency surgery to repair the artery needs to happen within the first couple of hours, Trahanas said. The vast majority of people who are able to have surgery — about 80% — will survive, he said. But the risk of dying increases about 2% for every hour that surgery is delayed.

High blood pressure is a key risk factor

Aortic dissection is rare, but it is more common among men and risk can increase with age. It may also be triggered by a particularly stressful situation among people who have high blood pressure at baseline. According to the medical examiner, Graham’s aortic dissection was “due to Arteriosclerotic Cardiovascular Disease.” Atherosclerosis — a condition where fats and cholesterol build up on the artery walls — is also a risk factor.

Hours before his death, Graham had returned from Kyiv, one of many he visits he had made since Russia invaded Ukraine in 2022.

“One might imagine that (Sen. Graham) had a stressful meeting in Ukraine,” Trahanas said, noting that he does not know the specifics of Graham’s case. If his blood pressure was up, it could have caused a tear, “which is a very, very sudden event that unfortunately can be fatal,” Trahanas said.

Sometimes an aortic dissection is “bad luck,” he said, but some people are predisposed due to a family history of aneurysm or connective tissue disorders.

Preventing aortic dissection

Still, there are a lot of preventative steps that can be taken, experts say.

Managing blood pressure is critical. This can help keep the stress on the aorta to a minimum by limiting how much it has to stretch.

People who are predisposed to certain risk factors can also get screened and meet regularly with an aortic specialist. Specialized aortic centers “can provide multidisciplinary care, genetic testing, and have access to clinical trials that may not be available at other centers,” Trahanas said.

Aortic dissection is “not a common diagnosis,” Hamilton said — there are about three to five cases for every 100,000 people each year.

“This isn’t something that the average person should be highly concerned with,” she said. “But when it happens, the mortality rate is very high.”

It’s important for people to understand their family history, know if they have any modifiable risk factors, pay attention to their blood pressure, and seek specialized care when appropriate.

“This just goes into the whole picture of staying on top of one’s health and understanding that there’s a lot of things out there that can get you,” she said. “But if you’re able to take care of yourself and modify risk factors as you know about them, that can be helpful.”

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