Endovascular surgery

600

Book

Journal of VASCULAR SURGERY

reviews

tional aortorenal bypassgrafting and other unconventional techniques such as hepatorenal and splenorenal bypass grafting with reversed saphenous vein almost exclusively. Prosthetic bypass grafts are mentioned but not described. Endatterectomy procedures have been entirely omitted, Several pages are expended in describing iliorenal bypass grafting for use in the presence of badly diseased aorta. There should be little indication for the procedure in modern vascular practice. Those interested in renal transplantation will find extensive and authoritative treatment of the subject in several chapters. Dialysis accesssurgery is also dealt with in detail. The preface to the first edition emphasized the importance of a multidisciplinary approach to renovasculardiseaseand stated that ‘Close cooperation with intestinal and vascular surgeons, when necessaryin difficult cases,may well provide the margin between successand failure.” This admonition should perhaps apply to most renovascular procedures that have the potential to become ‘difficult” in the hands of an occasional or inexperienced surgeon. Some surgical procedures described in the book with deceptive simplicity, such as“extracorporeal microvascular repair of multiple branch artery stenoses,” cannot be performed safely except by a surgeon who is highly expert in the field. Unfortunately, the difficult and complex nature of many of the renovascular operations detailed in the book has not been adequately emphasized by the authors. This criticism aside, the book is an excellent resource for the renovascular specialistand should find a place asa reference on the library shelf. The diagrams are excellent and the descriptions unambiguous and clear. The handsome twovolume set has been attractively produced by the publisher. Seshadri Raju, MD University

of Misstisisippi Medical

Center

Endovascnlar surgery Wesley S. Moore, Samuel S. Ahn, eds. Philadelphia, 1989, W. B. Saunders, 572 pages, $90.00. Readers of the JOURNALOF VASCULAR SURGERY will have no trouble recognizing many authors of the various sectionsin this important volume. However, an equal number of the contributors will be unknown to readers of surgical vascular literature. This is true because some authors are engineers, some are executives, many are physicians largely interested in cardiology, and at least one is a marketing manager. These authors bring with them a new vocabulary, which must be mastered by vascular surgeons. Thus it is no surprise when a professor of electricalengineering refers to a “cladded optical wave guide,” but it is slightly startling to recognize an authoritative vascularsurgeon’s casual use of the term “planoconvex lens.” Corporations producing the instruments described are also new to us. Nevertheless,

we must learn the new vocabulary and recognize the new players in the game. This volume is the product of a conference held in Los Angeles in May 1989 sponsored by the editors. Their concept of endovascular surgery and the organization of a multidisciplinary team provides the introduction. The sometimes taboo subject of professional billing is touched on as are the skills of the individuals who might make up the team. The volume dives deeply into the subjects of vascular endoscopy, balloon angioplasty, mechanical atherectomy, laser and thermal angioplasty, and adjunctive procedures. Strengths of the multiauthored volume include confident authoritative and experienced presentations. Weaknesses appear as lack of scientific depth and show up in contributions hastily penned by contributors whose calendar commits them to too many meetings, too many abstracts, too many chapters. Such brief contributions are more than compensated for by virtnal monographs such as the chapters on laserphysics, design considerations for angioplasty, and laser arterial wall interactions and histologic responses. Unexpected candor is found, for example, Ginsburg’s answer to the question ‘What can a laser system do that a balloon system alone cannot?” Answer, “from the data to date, not much.” In addition to candor, there is organization in this volume. Most sectionsinclude commentary on the future. In this regard, Ginsburg again emerges as a prophet saying, “I would predict that laser-assistedballoon angioplasty will probably soon disappear as a procedure.” Other commentary in other chapters is equally definite. One further quote summarizesthe contents of this entire volume. This one from the chapter on laser and thermal angioplasty states,“. . . all of these new modalities will eventually stand or fall on the assessmentof the success in the clinical situation, and on whether they can demonstrate any advantage over other available techniques.” It is the opinion of this reviewer that the fundamental problem of the arterial response to injury is not dealt with sufliciently in this volume. Vascular surgeons know the responseof the arterial wall to endarterectomy as an injury. Transplant surgeons know the response of the arterial wall to immunologic injury. Even surgical residents know the response of the arterial wall to anastamotic and clamp injury. Therefore, it should not be surprising to radiologists to find that hyperplastic tissue response allows tissue to grow through the interstices of stems placed to supplement balloon angioplasty. Predictably, endovascular surgery will succeedor fail depending on the response of fundamental scientific investigations to the questions posed by myointimal hyperplasia. John J. Began, MD Clinical Projksar of Surgery University of California, San DieJo Scripps Memorial Hospital, La Jolla