What is Aortic Dissection? What We Can Learn From Senator Lindsey Graham's Emergency

Senator Lindsey Graham, of South Carolina, died suddenly on July 11, 2026. His office initially described it as a “brief and sudden” illness. The next day, the medical examiner reported that Graham had died from an aortic dissection associated with "arteriosclerotic cardiovascular disease." He was 71 years old.

Aortic dissection isn't common. But it can be life-threatening and can happen suddenly, sometimes in people who appear to be completely healthy. Graham had recently returned from a trip to Ukraine and, according to the people around him, appeared to be doing well.

His death is a reminder that aortic disease can sometimes remain silent until a serious event occurs. We spoke with Behzad Farivar, MD, a vascular and endovascular surgeon and the codirector of UVA Health's Aortic Center, about what you should know about aortic dissections. "An aortic dissection can happen suddenly, but recognizing the warning signs quickly can save a life," he says. Here’s what you should know about aortic dissections.

What Is the Aorta?

Your aorta is your body’s largest blood vessel. It is about the size of a garden hose and has a curved shape as it begins from the top the heart.

It starts at your heart, travels up and then curves back down in your chest (an area called the aortic arch), and then runs down through the chest and abdomen, sending blood out from your heart to the rest of your body.

The wall of the aorta has three layers, which work together to withstand the pressure of blood being pumped out of the heart.

What Is an Aortic Dissection?

An aortic dissection happens when a tear develops in the inner layer of the aortic wall. Blood then enters into the wall and can force the layers apart, creating a new channel within the wall of the aorta.

This can cause two major problems:

• It can block blood flow to important organs, including the brain, heart, kidneys, intestines, or legs

• It can weaken the aortic wall and cause the aorta to break open (called a aortic rupture)

Both issues can be life-threatening and require immediate medical attention.

Doctors generally divide aortic dissections into two types, based on where the dissection happens in the aorta:

• Type A aortic dissections involve the part of the aorta closest to the heart, where it goes up from the heart (called the ascending aorta). They're generally surgical emergencies.
• Type B aortic dissections don't involve the ascending aorta, instead usually beginning in the part further along the aorta that leads down into your body (called the descending aorta). Many patients with this type can be treated with medication at first, but some require urgent procedures or surgery because of complications.

What Raises Your Risk for Aortic Dissection?

One of the most important risk factors for getting an aortic dissection is high blood pressure, especially when it's not controlled well. Over time, high blood pressure can place a lot of stress on the wall of the aorta.

Other risk factors include:

• Atherosclerosis, or hardening of the arteries, particularly in older adults
• Smoking
• A bicuspid aortic valve, meaning the valve has two leaflets instead of the usual three
• An aortic aneurysm, which is a weakened and enlarged area of the aorta
• Inherited conditions such as Marfan syndrome, Loeys-Dietz syndrome, or vascular Ehlers-Danlos syndrome
• A close family member who has had an aortic aneurysm or dissection
• Certain other conditions that weaken the aortic wall

An aortic dissection can occur at different ages for different reasons. In younger people, it's more likely to be associated with an inherited condition or other problem with the aorta. In older adults, long-standing high blood pressure and other forms of aortic disease are more important risk factors. Farivar says, "We can't always predict aortic dissection, but we can reduce risk. Controlling blood pressure and knowing your family history are two of the most important things you can do." Additionally, "If you have a close family member who has had an aortic aneurysm or dissection, that's important information to share with your doctor."

What Are the Aortic Dissection Warning Signs?

The classic symptom is sudden, severe chest or upper back pain that may feel like tearing, ripping, or very intense pressure-like pain. “The pain of an aortic dissection is often very different from an ordinary chest ache," notes Farivar. "Patients may describe it as sudden, severe, or tearing, sometimes involving the chest, back, or abdomen. If you or a loved one develops sudden, severe pain that feels fundamentally different from anything you've experienced before, don't wait. Call 911 immediately.”

Other symptoms can include:

• Sudden, severe abdominal pain
• Trouble breathing or passing out
• A weak or absent pulse in an arm or leg
• Stroke-like symptoms, like vision changes, trouble speaking, or weakness on one side of the body
• New weakness or pain in an arm or leg

A dissection can cause issues with blood flow to your heart, brain, spinal cord, kidneys, intestines, or legs. Because of this, it can sometimes look like a heart attack or stroke.

Again, if you or someone near you has sudden and severe chest, back, or abdominal pain, or suddenly has neurologic symptoms, call 911 right away.

How Are Aortic Dissections Diagnosed and Treated?

When doctors suspect an aortic dissection, computed tomography angiography (CTA; it's a special kind of X-ray that uses contrast to show your blood vessels) is usually the fastest and most useful test. It can provide detailed images of the aorta and show where a dissection begins and how far it extends.

Other tests, including echocardiography and MRI, can also be useful in certain situations.

Treatment depends on the type of dissection and how bad it is:

• Type A aortic dissections generally need emergency open surgery because they involve the ascending aorta and can quickly lead to life-threatening complications.
• Type B aortic dissections are often first treated with medication to control blood pressure, heart rate, and the stress placed on the aortic wall. When complications happen (like a rupture, reduced blood flow to organs, uncontrolled blood pressure or pain, or enlargement of the aorta) an endovascular procedure using a stent-graft or, in some cases, open surgery may be necessary.

Farivar notes that "there is no one-size-fits-all approach to aortic disease. Treatment depends heavily on the location and extent of the tear, requiring a coordinated team of specialists to act fast and deliver the precise care that specific patient needs."

After treatment, you'll need life-long follow-up care. Blood pressure control and regular imaging are important because the remaining portions of the aorta can continue to change over time.

Can Aortic Dissection Be Prevented?

Not every aortic dissection can be prevented. But there are important steps you can take to reduce your risk and identify aortic disease before an emergency happens:

• Keep your blood pressure under control and take prescribed medications regularly
• Don't smoke
• Get regular medical checkups and know your blood pressure numbers
• If a close family member has had an aortic aneurysm or dissection, tell your doctor
• Ask whether you should have your aorta evaluated if aortic disease runs in your family

Some forms of aortic disease can be detected before they cause symptoms.

For example, an abdominal ultrasound (a special type of imaging that uses sound waves to create a picture of what's inside of you) is a simple, noninvasive way to screen for an abdominal aortic aneurysm (AAA). Current guidelines recommend screening for AAA in adults ages 65 and older who have a family history of AAA or who have ever smoked. Screening is also considered in certain other people with significant risk factors. "Knowing your family history and getting appropriate screening when you're at increased risk can help us detect aortic disease before it becomes an emergency," Farivar says. "Sometimes that may be as simple as an ultrasound, while people with certain risk factors may need more detailed imaging of the aorta." The right type of imaging to use, like a CTA, depends on a person's age, symptoms, family history, and other risk factors.

For people with a family history of aortic aneurysm or dissection, doctors may recommend imaging of the aorta and, in some cases, genetic testing to look for inherited conditions that increase the risk of aortic aneurysm or dissection.

Finding an aneurysm or an inherited risk for aortic disease before an emergency happens can give healthcare providers an opportunity to monitor the aorta closely and, when appropriate, treat it in a planned setting rather than during an emergency.

Senator Graham’s death is a reminder that aortic dissection can happen suddenly, sometimes in someone who appears to be healthy. Knowing the warning signs, and knowing your own risk factors, can help you recognize this potentially life-threatening condition and seek treatment quickly.