Low arginine plasma levels in patients after thoracoabdominal aortic surgery

Objective: Thoracoabdominal aortic surgery is a high-risk procedure and associated with a significant morbidity and mortality. Ischemia reperfusion of visceral organs and lower extremities is one of the most important determinants of this morbidity. Arginine is the precursor of nitric oxide and arginine plasma levels are important in maintaining organ blood how. Furthermore, arginine is important in wound healing and the immune system. Because of increased utilization of arginine, low arginine plasma levels could be expected after thoraooabdominal aortic surgery. We therefore measured arginine plasma levels in these patients. Design: Six patients with thoracoabdominal aortic aneurysm were included in this study. Setting: University Hospital Vrije Universiteit, Department of Surgery, Amsterdam, The Netherlands. Subjects: Six patients undergoing thoracoabdominal aortic surgery. Intervention: Plasma levels of arginine were measured by high-performance liquid chromatography. Results: Very low arginine plasma levels were seen on the first postoperative day. From day 1 arginine slowly increased, but did not reach normal plasma levels on day 6. Conclusions: A significant decrease of arginine plasma levels was found and because of the fact that arginine has multiple functions, it may be important to keep these arginine plasma levels at normal or even higher levels in patients undergoing major vascular surgery.