Book Review

Diagnosis and Treatment of Aortic Diseases

N Engl J Med 1999; 341:1403-1404October 28, 1999

Article

Diagnosis and Treatment of Aortic Diseases
(Developments in Cardiovascular Medicine, Vol. 212.) Edited by Christoph A. Nienaber and Rossella Fattori. 278 pp., illustrated. Boston, Kluwer Academic, 1999. $127. ISBN-0-7923-5517-2.

With the increasing focus of both vascular medicine and vascular surgery on vascular-wall biology, students of aortic disease have come to expect that books on the subject will incorporate discussions of nitric oxide, endothelin, shear stress, proteoglycans, and matrix metalloproteinases and relate these to clinical diseases. Such is not the case with this grandly titled slender book, edited by Nienaber of Hamburg, Germany, and Fattori of Bologna, Italy. This is most definitely a book about “what,” certainly not a “how” or “why” book. It consists of only 278 pages, including many devoted to extensive bibliographies, thus leaving space for only limited consideration of the selected topics.

Nienaber is an interventional cardiologist at the University of Hamburg with a special interest in cardiovascular imaging, whereas Fattori is an interventional radiologist in Bologna who also has a special interest in cardiovascular imaging. These interests doubtless explain the considerable but by no means exclusive focus on aortic imaging throughout the book. The eclectic selection of topics suggests a failure to realize that cardiac surgery and vascular surgery are quite different; the anatomical dividing line between the two is generally agreed to be at the level of the left subclavian artery. In a limited book such as this, the dedication of a relatively large amount of space to surgery of the aortic arch is difficult to understand. The scope of the book, which spans the philosophically great distance from the aortic valve to the aortic bifurcation, seems to ensure that few specialists will find much that is new therein.

The basis for the selection of the seven chapters is never clear. Whereas the sections on aortic dissection, aneurysms (including those of the ascending aorta, the aortic arch, the descending aorta, and the abdominal aorta), aneurysm surgery, and aortic trauma lie squarely in the arena of medical and surgical treatment, the remaining sections (on aortitis, inherited aortic diseases, and curiously, anomalies of the aortic arch) stray far afield. On balance, I came away from this book feeling as though I had made a series of small discrete journeys rather than progressed in an orderly fashion from one logical point to another.

In regard to the strengths and weaknesses of the book, several points seem clear. Given the space limitation, there was simply no room for alternative points of view or the presentation of scientific information underlying clinical data or decision making. For example, scant attention was paid to the repair of thoracoabdominal aneurysms or the repair of aneurysms by endograft.

A strength of this book is its unambiguous presentation of facts in a clear and uncomplicated expository style. The bibliography is extensive and generally up to date. Unfortunately, many of the line drawings were reproduced poorly and are visibly smudged and unclear. Although a considerable amount of imaging data was reproduced clearly, there are no arrows pointing to the portion of the image being discussed. At many points, the translation of the writing into English is awkward — hardly what one would expect from a major publisher.

Advanced students of aortic disease, including cardiac and vascular surgeons and senior trainees, will find limited value in this book. However, for readers at a more junior level, including medical students and junior trainees, the advantages of an uncomplicated book may be considerable. It is for these readers that the book will be most useful.

John M. Porter, M.D.
Oregon Health Sciences University, Portland, OR 97201-3098