Book Review

Vascular Diagnostics: Noninvasive and invasive techniques, periinterventional evaluations

N Engl J Med 1996; 334:1675June 20, 1996

Article

Vascular Diagnostics: Noninvasive and invasive techniques, periinterventional evaluations
Edited by P. Lanzer and J. Rösch. 528 pp., illustrated. New York, Springer-Verlag, 1994. DM 198. ISBN: 0-387-57939-7

As diagnostic testing for vascular disease continues to evolve, the borderline between noninvasive and invasive techniques has become blurred. For example, contrast angiography is clearly an invasive procedure, and methods based on ultrasound are generally considered noninvasive, but computed tomographic angiography, which relies on the use of ionizing radiation and intravenous contrast material, might be regarded as minimally invasive. Intravascular ultrasound combines invasive catheterization techniques with the ability to evaluate vascular abnormalities by noninvasive imaging. Similarly, the distinction between diagnostic and therapeutic approaches has become less clear with recent advances in the field of catheter-based interventional techniques. Current therapeutic options include not only conventional balloon angioplasty, but also atherectomy, stenting, catheter-directed thrombolysis, and intravascular grafting. The invasive techniques of contrast arteriography and venography are now used primarily as adjuncts to intervention, since they are no longer required solely for diagnostic purposes.

These trends are reflected in the subtitle of the book Vascular Diagnostics: Noninvasive and Invasive Techniques, Periinterventional Evaluations, which is intended, as the editors state in their preface, “to provide an interdisciplinary perspective of the clinically applicable noninvasive and invasive diagnostic evaluations of the cerebral, coronary, visceral, and peripheral vasculature, and where appropriate, of the corresponding vascular-related end-organ function.” The interdisciplinary character of the book is exemplified by the long list of 75 authors, drawn from the specialties of radiology, vascular surgery, cardiology, internal medicine, engineering, and neurology. About two thirds of the authors are from Europe, and the remaining third are predominantly from the United States.

The book has three parts. The first, on noninvasive techniques, covers such diverse topics as the vascular physical examination, traditional indirect noninvasive methods, diagnostic aspects of lipid abnormalities, and homocysteine metabolism. It is appropriate, however, that the emphasis of this part is on vascular ultrasonography, from basic imaging technology to specific areas of application in the carotid arteries, abdominal vasculature, and peripheral vessels. These chapters are especially well illustrated with numerous B-mode, spectral-wave-form, and color-flow images. The quality of the color images, which is crucial to a textbook of this type, is excellent. The second part of the book deals with invasive techniques and periinterventional evaluations. General discussions of radiographic imaging and contrast agents are followed by coverage of specific anatomical areas, including the extracranial and intracranial vessels, the coronary arteries, the thoracic and abdominal arteries, and the peripheral arteries. This part concludes with a chapter on central and peripheral venography. Although most of the material reviewed in the first two parts of the book is generally known and accepted, part three, titled “Work-in-Progress,” attempts to look ahead by examining the new and emerging forms of technology in vascular diagnosis: vascular magnetic resonance techniques, computed tomographic angiography, intravascular ultrasonography, and angioscopy. These chapters include detailed discussions of the physical principles that form the basis of these methods and the potential advantages and limitations of each approach. As suggested by the title of this part, the clinical role of these new diagnostic methods will only become clear with further experience.

The book has only a few weaknesses worth mentioning. There are more typographic errors than would ordinarily be expected in a book of this high overall quality. There are also occasional idiosyncrasies of English usage that are easily overlooked when one recognizes that English is not the first language of some of the authors.

This book will be of interest to the interdisciplinary audience referred to in the editors' preface and reflected in the diverse specialties of the authors. Some specialists, particularly vascular surgeons and interventional radiologists, may find the coverage of their own fields too basic, but the wide scope of topics ensures that all will have much to learn.

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