Book Review

Recent Advances in Cardiology

Vascular Diseases: Surgical & Interventional Therapy

N Engl J Med 1994; 331:1388November 17, 1994

Article

Vascular Diseases: Surgical & Interventional Therapy
Edited by D. Eugene Strandness, Jr., and Arina van Breda. 1269 pp. in two volumes, illustrated. New York, Churchill Livingstone, 1994. $295. ISBN: 0-443-08841-1

Vascular Diseases is an excellent, state-of-the-art discussion of the pathophysiology, diagnosis, and treatment of vascular disease. The contributing authors represent many of the leaders in vascular surgery and vascular imaging, the latter being an area often poorly represented in standard textbooks of vascular surgery. The two-volume textbook discusses the operative management of vascular diseases in general terms, but it does not focus on specific techniques, and most chapters lack illustrations of operative techniques.

The discussions of the pathophysiology of arterial and venous disease are excellent, incorporating current research and clinical data. The focus on applying knowledge of the physiology of arterial and venous disease to clinical practice is a major strength of the book. The concise sections on the anatomy and physiology of the venous system and on the pathophysiology of deep venous thrombosis contain excellent references.

The fine section on diagnostic techniques in vascular repair is an important contribution. These discussions contain concise, clinically applicable information about the plethora of techniques available for the diagnosis and follow-up of vascular disease. The section by E. Kent Yucel on magnetic resonance angiography, the most advanced noninvasive imaging technique now available, is particularly important.

The comprehensive discussion of atherosclerotic and nonatherosclerotic limb ischemia takes a somewhat limited view of vascular trauma. The section on vascular trauma, although excellent, does not offer much substantial information on the pathophysiology of vascular trauma, patterns of vascular injury, clinically important missed injuries, or operative techniques used with patients with vascular trauma.

The discussions of chronic arterial disease cover all aspects of peripheral vascular disease but are somewhat limited in the areas of extended limb-salvage bypasses to the pedal arch or branches. It would have been beneficial, in view of the continuing controversies, to have provided more detail on techniques of vascular repair and the indications and outcomes of these procedures. The chapters on the management of arterial aneurysms are excellent, especially the sections on the imaging and clinical management of aneurysms.

Volume 2 covers extracranial arterial disease, renovascular hypertension, visceral arterial disorders, venous disorders, arteriovenous access, arteriovenous fistulae and malformations, and complications of therapy. The comprehensive and concise section on renal vascular hypertension highlights one of the major strengths of the textbook: problem-oriented discussions of invasive and noninvasive imaging techniques. The final section, on complications of therapy, is extremely comprehensive and of substantial value to the clinician. It highlights not only the complications of surgery but also those of interventional therapies, an increasing problem in the care of patients with vascular disease. The important section on the complications of cerebral, renal, and splanchnic disease presents difficult areas of diagnosis and therapy for the practicing clinician.

This textbook comprises two volumes, but it is well organized and allows the reader easy access to specific topics. The reference lists are excellent and include many recent articles, not just historical manuscripts. Vascular Diseases is a valuable clinical reference for all involved in the care of patients with vascular disorders.

Susan Briggs, M.D.
Massachusetts General Hospital, Boston, MA 02114