Aortic Dissection: What to Know About Lindsey Graham’s Death

Sen. Lindsey Graham (R-S.C.) died at age 71 of an aortic dissection caused by arteriosclerotic cardiovascular disease, according to a preliminary medical examiner’s report.

An aortic dissection is a rare and painful event that can ultimately cause life-threatening internal bleeding or block the flow of blood from the heart to other organs. Complications of aortic dissection include stroke, aortic valve damage, heart attack, heart failure, kidney damage, cardiac tamponade, and death.

Dissection occurs when a weak area of the aorta develops a split in the intimal layer and leads to the separation of the aortic wall layers (unlike an aortic aneurysm rupture, a significant burst through all of the layers of the aorta wall). Dissections are often linked to bulging aortic aneurysm but can also occur in the absence of one.

Graham died on Saturday and his autopsy was completed Sunday.

“The death certificate will be pending until all the toxicological and microscopic testing are finalized and at that point the death certificate will be updated to reflect the cause of death and appropriately classify the manner of death,” noted the office of Francisco Diaz, MD, chief medical examiner in Washington, D.C.

Audio from emergency medical services indicated an initial response to a call for “cardiac arrest” at Graham’s home just after 8 p.m. Saturday. Subsequent communications suggested that CPR was administered roughly 20 to 25 minutes later. Graham was reportedly then transported to George Washington University Hospital, where he was pronounced dead at 10:23 p.m.

Graham’s office said he’d died “from a brief and sudden illness” and, indeed, aortic dissections can happen without warning. While they tend to occur due to a sudden rise in blood pressure or heavy exertion, aortic dissections have also been known to occur at rest.

Graham had just returned from a trip to Kyiv, Ukraine, where he met with President Volodymyr Zelensky on Friday.

Details are lacking on Graham’s condition or care upon arrival at the hospital. Type A aortic dissections are surgical emergencies that usually require emergent operative repair, with ascending aortic hemiarch replacement being standard and the more extensive arch reconstruction intended to decrease the long-term risk of additional open aortic surgery.

Surgery may be put off for less severe Type B aortic dissections, which can be treated conservatively with heart rate- or blood pressure-lowering medications.

Traditional risk factors for aortic dissection include older age, ongoing hypertension, atherosclerosis, tobacco product use, and connective tissue disorders. Cold weather is also thought to trigger acute aortic dissections.