In coronary artery bypass surgery, arterial grafts result in improved patency rates. However, these grafts frequently fail due to spasm. Papaverine has been used to prevent graft spasm, but its effect is short-lived. Botulinum toxin inhibits muscle contraction for about three months. We investigated the usefulness of botulinum toxin in preventing arterial grafts spasm in vitro. Samples of abdominal aorta from male Wistar rats were cut into 2 mm rings and treated with various doses of botulinum toxin or papaverine for 30 min. All rings were stimulated with KCl and noradrenaline. Tension was recorded using myography. We compared constriction caused by noradrenaline or KCl in rings treated with botulinum toxin, or papaverine, or physiological salt solution (PSS) (control). In the presence of KCl and noradrenaline, almost all concentrations of botulinum toxin completely inhibited arterial contraction when compared with controls. Spasm prevention was lost after 60 min in rings with papaverine but persisted for 120 min in rings with botulinum toxin. In the histological examination, arterial wall structure was not destroyed by botulinum toxin. Botulinum toxin prevented arterial graft spasm in vitro and had a longer lasting effect than papaverine, with no toxic effect on the artery.

Gastroduodenal artery aneurysms are uncommon. The majority of them are false or pseudoaneurysms, often seen in the setting of inflammation, specifically with pancreatitis. True aneurysms of gastroduodenal artery are extremely rare. As risk for rupture is unrelated to size, any gastroduodenal artery aneurysm should be considered for definitive treatment once the diagnosis has been made. A successful case of surgical repair of true gastroduodenal artery aneurysm in a patient with liver cirrhosis is reported in this study.

The middle aortic syndrome (MAS) is a rare disease affecting children and young adults, and it occurs in about 0.5% to 2.0% of all aortic coarctation cases. Congenital, acquired, inflammatory, and infectious etiologies have been described. In the majority of cases, there is a short, isolated or diffuse tubular narrowing of the descending thoracic and abdominal aorta, often accompanied by ostial stenosis or occlusion of the renal and visceral branches, which leads to renovascular hypertension and visceral ischemia. Surgical treatment should be considered in cases of uncontrollable hypertension, evidence of end-organ damage such as cardiac failure, progressive renal insufficiency, or severe intermittent claudication. Several surgical treatments for this condition have been reported, including bypass grafting, graft replacement, or patch angioplasty. We report a successful case of ascending aorta-abdominal aorta bypass for MAS in a 11-year-old boy.

Mediastinitis following ascending aortic replacement is intractable and potentially fatal, and the feature is characterized as having both high mortality and morbidity when its causation pathology is methicillin-resistant Staphylococcus aureus (MRSA). Possible treatments for the condition, which include debridement, irrigation, and healthy tissue transposition, often result in failure. We report a case of MRSA mediastinitis after replacement of the ascending aorta and the aortic valve successfully treated by continuous saline lavage and drainage, debridement, high-pressure irrigation, and gentian-violet application, and delayed omental-flap transposition. The application of gentian violet and high-pressure irrigation may provide an additional option to the standard therapy for intractable mediastinitis after ascending aortic replacement.

We describe the first Marfan syndrome case of non-traumatic bilateral radial artery aneurysms in the anatomical snuff box. A 74-year-old woman with Marfan syndrome had a pulsatile mass in her bilateral anatomical snuff box. The color Doppler ultrasonography showed an aneurysm of radial artery located in the bilateral anatomical snuff box. Resection of the right radial artery aneurysm was completed without complications. Histopathological analysis showed a true aneurysm with atherosclerotic changes in the arterial wall. We review the literature on non-traumatic or bilateral radial artery aneurysm in the anatomical snuff box, and discuss the clinical presentation and surgical management.