Doctors explain aortic dissection, the condition linked to Sen. Lindsey Graham’s death

SAVANNAH, Ga. (WTOC) -A preliminary medical examiner’s report indicates Sen. Lindsey Graham died of an aortic dissection — a tear in the inner lining of the main artery leading from the heart. Graham died Saturday July 11 at age 71.

Local heart doctors spoke Tuesday about the condition, its symptoms, and the urgency of treatment.

A St. Joseph’s/Candler cardiologist explained that an aortic dissection occurs when the inner lining of the aorta tears, immediately obstructing blood flow. Doctors said a tear closer to the heart is considered more serious and requires the fastest possible medical attention.

‘A very dire emergency’

Interventional cardiologist Akinniran Abisogun of St. Joseph’s/Candler described the condition using a common comparison.

“Think of it like a water hose. If the inner lining of the water hose tears, then water doesn’t get out to the other side. So in aortic dissection, that main hose in your body, the aorta, is torn from the inside and blood cannot get to the other side,” Abisogun said.

Abisogun said the condition carries a high risk of death and can worsen rapidly.

“An aortic dissection is a very dire emergency with a high mortality. So if you have that tearing chest pain, whether it’s a dissection or not, you’re not going to know unless you come to the hospital and seek urgent medical care,” Abisogun said.

He added that the longer the condition goes untreated, the more it can spread.

“The longer it sits there, the more it propagates or spreads, and the worse the damage is. Sometimes it can even lead to rupture of the vessel or poking a hole in your aorta, which is deadly as well,” Abisogun said.

Risk rises by the hour

Cardiac surgeon Dee Prastein of St. Joseph’s/Candler said the risk of death increases with every hour the dissection goes untreated.

“Every hour after the dissection is diagnosed increases the risk of death by 1%. So within 48 hours the risk of death goes up to 50%. So as soon as we diagnose it, we treat it,” Prastein said.

Prastein said the dissection does not stay in one location.

“It doesn’t just remain focal in one spot, it goes all along the length of the aorta, extending into the abdomen and into the legs. So if we have an injury in the inner lining of the aorta where the blood is supposed to be, it can seep into any one of those compartments and it can do two things. You can bleed around the heart, which is fatal, or you can obstruct blood flow to the arteries that supply blood to the heart, which is also fatal,” Prastein said.

Symptoms and prevention

Doctors said symptoms of an aortic dissection can resemble those of a heart attack. The key warning sign is a sharp pain that radiates between the back and shoulder blade. Other symptoms include loss of vision, stroke, and a difference in blood pressure between one side of the body and the other. Doctors said the condition can be diagnosed through C.T imaging.

Prastein said hypertension is a common factor found in patients.

“About two-thirds to three-quarters of patients on autopsy findings, they’ve noticed that they all have, as a common factor, hypertension,” Prastein said.

Doctors said the best prevention methods include controlling risk factors such as high blood pressure, cholesterol, and not smoking.

When asked whether Graham’s recent trip to Ukraine played a role in his death, Abisogun said that is speculative. He said high stress, anxiety, and anything that elevates heart rate can worsen the condition.

A rare and complex surgery

Prastein said the surgery required to repair an aortic dissection is unique and not something performed routinely at St. Joseph’s/Candler. She said patients are placed under anesthesia and then into a deep hypothermic circulatory arrest — a process that temporarily stops circulation while surgeons repair the tear. Prastein said surgeons remove the torn portion of the aorta and replace it with a vascular synthetic graft.