Book Review

Technologies in Vascular Surgery

N Engl J Med 1993; 328:592February 25, 1993

Article

Technologies in Vascular Surgery
Edited by James S.T. Yao and William H. Pearce. 525 pp., illustrated. Philadelphia, W.B. Saunders, 1992. $130. ISBN: 0-7216-4429-5

In the preface to this new book, Drs. Yao and Pearce of the Northwestern University Medical School state that their purpose is “to examine the recent growth of technologies and their effectiveness in the diagnosis and treatment of vascular problems.” Although all areas of medicine have benefited from advances in technology, the development of vascular surgery as a distinct subspecialty over the past 50 years has been stimulated by numerous technical breakthroughs in areas such as anticoagulation, anesthesiology, and diagnostic radiology. To achieve their goal, the editors have assembled 40 chapters by 106 authors; the book is divided into six sections.

The first section covers selected topics in molecular biology and genetic engineering, including the effects of hemodynamic forces on endothelial-cell gene expression, the genetics of aortic aneurysms, and endothelial-cell seeding of arterial bypass grafts. The second section, on new diagnostic radiologic technology, and the third section, on noninvasive diagnostic technology, are especially pertinent to the theme of this book, since the new approaches described are clearly the products of modern technology. Although conventional contrast arteriography had a central role in the early development of vascular surgery, equivalent information can now be obtained by safer, less invasive methods at lower cost. Alternatives to arteriography include magnetic resonance angiography and color-flow ultrasound imaging. In addition to anatomical information, these new techniques can provide useful physiologic data on flow patterns within the vessels of interest.

The fourth section covers the field of intravascular diagnostic technology and contains discussions of intravascular ultrasonography and angioscopy. These two approaches are technical modifications of existing methods that have combined invasive and noninvasive techniques to generate new clinical applications. The rapidly expanding field of interventional technology is covered in the fifth section, with discussions of standard balloon angioplasty, laser angioplasty, atherectomy techniques, and vascular stents. The process of myointimal hyperplasia can threaten the success of any interventional procedure, and the underlying mechanisms of this problem and possible solutions are covered in an important chapter on the pharmacologic control of myointimal hyperplasia. The sixth section, on thrombolytic therapy, concludes the book with discussions of the new thrombolytic agents and their applications in arteries, veins, and bypass grafts.

Overall, the editors have succeeded exceptionally well in achieving their goal. This book brings together material from diverse fields that would not typically be presented in a single volume, and it is remarkably up to date for a book of its scope and length. Since a major portion of the book is devoted to new imaging techniques, illustrations are an important part of the book; it contains numerous clearly reproduced images, including many examples of color-flow Doppler ultrasonograms.

Vascular surgeons and interventional radiologists will be the primary audience for this book, but it should also be of interest to other physicians, vascular technologists, and sonographers who are involved in the diagnosis and treatment of vascular disorders. It provides a valuable review of the most recent advances and a look toward the future of this rapidly changing field. On the basis of the material presented, it can be concluded that, for the most part, advances in technology have provided us with methods for the diagnosis and treatment of vascular disease that are as accurate and efficacious as the traditional approaches, but safer and more cost effective.

R. Eugene Zierler, M.D.
University of Washington School of Medicine, Seattle, WA 98195

Citing Articles (1)

Citing Articles

1. 1

   Claudio Anasetti, M.D, Ruth Etzioni, Ph.D, Effie W. Petersdorf, M.D, Paul J. Martin, M.D, John A. Hansen, M.D. (1995) MARROW TRANSPLANTATION FROM UNRELATED VOLUNTEER DONORS. Annual Review of Medicine 46:1, 169-179
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