Book Review

Vascular Surgery: Theory and practice

N Engl J Med 1996; 334:338February 1, 1996

Article

Vascular Surgery: Theory and practice
Edited by Allan D. Callow and Calvin B. Ernst. 1776 pp., illustrated. Stamford, Conn., Appleton and Lange, 1995. $195. ISBN: 0-8395-9384-4

Since the two cardinal and generally dramatically overt clinical events caused by vascular disease are occlusion and rupture, it is quite natural, as the introductory chapter of this book notes, that solutions to vascular problems have developed from the innate plumbing instincts of surgeons. Vascular surgery has flourished amid an impressive array of technical achievements, but even as frontiers have been broadly advanced over the past half century, surgeons have been haunted by an awareness that less pliable biologic processes lurking at the cellular and biochemical level will ultimately frustrate definitive cure. It has become abundantly clear that control of fundamental events in the vessel wall is a critical prerequisite to future progress. To this end, an invigorating natural process of integration among vascular surgeons and colleagues in related fields is producing a remarkable multidisciplinary effort in patient care and research.

One of the principal motivations behind Vascular Surgery: Theory and Practice was “to provide the vascular surgeon, in practice and in training, with a `user-friendly' current source that acknowledges and interprets some of the immense amount of new knowledge of vascular disease and vascular biology that has appeared in the past several years.” Edited by two eminent senior vascular surgeons of the grand tradition, the book has an unabashedly surgical perspective, but with a uniquely firm foundation in fundamentals. The first 200 pages give an overview of the fruits of recent research in cellular and molecular biology of the arterial wall, circulatory physiology, and the inner workings of atherogenesis and intimal hyperplasia. The rest of the book is a more typical series of generally excellent and authoritative chapters by a refreshing mix of well-known and less familiar authors covering all angles of the wide array of vascular conditions. In accordance with the editorial design, chapters on such basics as hemodynamics, principles of ultrasound and other diagnostic methods, pathogenesis, and prosthetic-graft biology are scattered throughout. Updates of modern surgical therapy are nicely complemented by reviews of related pharmacologic approaches, percutaneous angioplasty and stenting, emerging minimally invasive angioscopic and endovascular grafting techniques, and perioperative medical care and morbidity. Included within the wide-ranging scope of the book are timely contributions on decision making, the accreditation of vascular laboratories, reporting and management standards, and the evaluation of outcomes. The book is extensively illustrated, featuring high-quality radiographic reproductions and three sections of color plates.

I have few criticisms. The organization of the book is rather haphazard and jumbled — a disconcerting but minor problem given the intrinsic strength of nearly all the chapters. The chapters on basic science are generally written by surgeons for surgeons, and future editions might widen the book's appeal by titrating more input from practical nonsurgical colleagues. Experienced readers may object to the somewhat opinionated tone of a few contributors and be frustrated by the overly brief treatment of a few topics, such as the vertebrobasilar syndromes, and rare omissions of others, such as surgery for varicose veins. It is inevitable that some excellent chapters on rapidly evolving topics, such as the randomized carotid-surgery trials, must be somewhat dated and that the ample reference lists rarely include citations as recent as 1994. The cost of future editions might be trimmed by a more selective use of the beautiful color plates. In keeping with other books in the modern heavyweight class, this single volume weighs fully 10 pounds, and many readers will welcome future editions on CD-ROM.

This book is a valuable new contribution to a complicated and rapidly progressing field. Conceptually by and for surgeons, defined by the editors as “internists who can operate,” the book presents an extraordinary wealth of basic and applied knowledge that will be of interest not only to surgeons but also to internists (and many others) who do not operate. It will be particularly helpful to practitioners of interventional radiology, vascular medicine, and cardiology who share with surgeons the care of patients with vascular disease. Vascular Surgery: Theory and Practice will take its rightful place within arm's reach of many discerning readers who will find its utility as a comprehensive and practical reference sufficiently valuable to ensure demand for future editions.

Magruder C. Donaldson, M.D.
Brigham and Women's Hospital, Boston, MA 02115