This chapter covers vascular pathologies in cases of natural death, with the exception of the coronary arteries, which are discussed in Chap. 20. In contrast to clinical pathologic institutes, the case spectrum of natural deaths in centers of legal medicine mostly comprises sudden, unexplained events. The most frequent cause of sudden natural death is cardiovascular disease, a condition that can be particularly well evaluated with multiphase postmortem computed tomographic angiography (MPMCTA). Some causes of sudden natural death, like hypoglycemia or septic or allergic shock, may not show specific imaging findings, and they cannot be ascertained by postmortem imaging. Tumors and infectious diseases are both usually associated with a longer medical history and observation, and thus are rarely sudden or unexpected. MPMCTA may be useful in cases of cancerous invasion of blood vessels and to exclude medical malpractice in these cases. Postmortem magnetic resonance imaging (PMMRI) may improve the diagnostic possibilities in certain situations but needs to be further evaluated.