Reductions in nitric oxide (NO) activity persist after arterial intimal injury and may be a factor in the development of intimal hyperplasia. NO inhibits in vitro platelet aggregation, leukocyte adhesion, and smooth muscle cell growth, all of which are key components in the process of intimal hyperplasia. We hypothesized that long-term supplementation with L-arginine, the precursor of NO, would increase NO production and thereby improve endotheliumdependent vasorelaxation and simultaneously reduce intimal hyperplasia. Twenty-six New Zealand White male rabbits were fed standard rabbit chow either with or without 2.25% L-arginine in their drinking water for 3 weeks. Then the animals underwent unilateral iliac artery angioplasty and were continued on their respective diets. Four weeks after angioplasty, the iliac arteries were harvested for functional and M echanically induced vascular intimal injury is characterized by prolonged reduction of endothelial cell nitric oxide (NO) release and concurrent development of intimal hyperplasia. Current evidence suggests that these phenomena may be causally related. Alterations in NO-mediated vasodilation persist in injured arterial segments even after regrowth of an endothelial cell monolayer.1 Recent in vitro experiments have shown that NO inhibits platelet aggregation, leukocyte adhesion, and smooth muscle cell growth, all of which are key components in the development of intimal hyperplasia. 25 Furthermore, administration of L-arginine, the NO precursor, to hypercholesterolemic rabbits has been shown to reverse defects in NO activity and reduce the development of proliferative atherosclerotic lesions. 6 We hypothesized that long-term administration of L-arginine would increase endothelial cell NO release at the site of balloon angioplasty injury, therefore increasing endotheliumdependent vasorelaxation while simultaneously reducing the intimal hyperplastic response to this injury.
Methods AnimalsTwenty-six New Zealand White male rabbits (3.5 to 5.0 kg body weight) were studied. All animals were housed individually in a controlled-temperature, standard light/dark environment and allowed to acclimate before any intervention or morphometric studies. The iliac arteries from several animals from each group were processed for study by electron microscopy. Maximal endothelium-dependent vasorelaxation in injured arteries was significantly greater in L-arginine-supplemented animals (mean±SEM, 71.8±4.1%; n=6) than controls (51.4±4.0%, n=7; P<.05). Furthermore, the intimal area in injured arteries was significantly reduced in L-arginine-supplemented animals (0.22±0.03 mm 2 , n=5) compared with controls (0.34±0.03 mm 2 , n=6; P<.05). These data suggest that L-arginine supplementation enhances NO production at sites of vascular healing and may reduce intimal hyperplasia. Animals were continued on their respective diets after angioplasty until they were killed, at which time the iliac arteries were excised and studied for vasomotor function and histomorphometry. The L-arginin...
The fate of the contralateral leg after infrainguinal bypass is affected by diabetes, coronary artery disease, contralateral ankle-brachial index, and age at initial ipsilateral bypass. The effect of these risk factors is additive in prediction of the likelihood of future intervention. Knowledge of these factors may help identify instances in which the contralateral greater saphenous vein will be important for future limb salvage and also determine which patients need more careful follow-up care.
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