Graham’s Death Raises Medical Questions
Sen. Lindsey Graham’s death at 71 from an aortic dissection has focused attention on the life-threatening condition. Details about his diagnosis and treatment are not available while a final death certificate is pending, but experts agree on both how serious it is and how suddenly it erupts after a long prelude.
Aortic Dissection: A Rare but Deadly Condition
One cardiothoracic surgeon had concerns about the South Carolina senator’s care. “Somebody of his stature and age surely has had access to very high-level medical care,” Mark Peterson, the system director of aortic surgery at NYU Langone Health, told STAT in an interview.
Peterson wondered if Graham had undergone an echocardiogram or imaging study of the chest, and if so, what the results showed. Patients who come to his aorta clinic often say they’d had an echocardiogram a few years ago that showed a dilated aorta — a predictor of dissection — or the bulging vessel wall of an aneurysm, but nobody took it seriously or told them about it.
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Risk Factors and Prevention
Aortic dissection is abrupt, but it doesn’t come out of nowhere. When the body’s most important blood vessel tears from the inside, it’s a medical emergency that can be years in the making. More common as people reach their 50s and 60s, it’s rare after age 80.
People diagnosed with atherosclerosis are vulnerable to sudden damage from high blood pressure hammering their arteries while fats, cholesterol, and calcium harden and narrow those vessels. Their weakened arteries widen, a warning sign that they might shear under pressure.
Cardiologist Eric Topol will never forget a patient who died outside his gym right after a workout. The man was considered at risk for an aortic dissection, based on imaging studies, and was warned against lifting weights.
Echocardiograms and CT scans offer a picture of blood vessel health, with guidelines based on vessel width dictating when surveillance should begin. Surgery can correct the problem, but it’s a major, high-risk operation to replace the weakened aorta with a graft. Another option is a minimally invasive repair that threads a stent into the artery to close the torn vessel lining.
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The Challenge of Predicting Aortic Dissection
Joanna Chikwe, chair of cardiac surgery in the Smidt Heart Institute at Cedars-Sinai, said improving risk prediction is one of the biggest unanswered questions in the field. “This is one of the biggest unanswered questions in the field,” she told STAT in an email interview.
Chikwe believes that combining genetics, clinical factors, imaging, biomechanics, and potentially AI can help identify people at high risk of aortic dissection. AI may help identify more subtle markers of risk by analyzing CT, MRI, or echocardiographic images.
Once the aorta ruptures, it’s a surgical emergency, Peterson said. When in doubt, call 911. “Treat it as a medical emergency,” Chikwe wrote. Longer term, she said, “aortic dissection is time-critical, and early diagnosis and treatment substantially improve survival.”
