- Email: [email protected]
Cardiovascular medicine (CD-ROM)
BOOK REVIEWS James O. Menzoian, MD, Book Review Section Editor Management of chronic lower limb ischemia Joseph Mills; London; 2000; Arnold Press; 143 pages; $89.50. The management of chronic lower limb ischemia continues to be a challenging and technically demanding aspect of vascular surgery. It is refreshing and timely, in the setting of refinement of old techniques and the development of new ones, to revisit the issues with an in-depth and highly readable text dedicated solely to this challenging subject. Dr Mill’s book organizes the management of chronic lower extremity ischemia from history through current variations under development, touching on technique, diagnosis, as well as pathophysiology. It is an extremely helpful contribution, an excellent text for students of vascular surgery, and sufficiently deep in content as to provide useful information even to the highly experienced lower extremity vascular surgeon. The book begins with a history of infrainguinal bypass, which despite the occasionally flowery text, places in perspective the enabling technical steps from the beginning of the century through the critical milestones appearing in the 1940s, 1950s, and 1960s. It also provides an overview for the techniques of the current era described later in the book. The chapter provides a unique perspective and an excellent jumping-off portion for the remainder of the monograph. The organization of the text to follow falls into the broad categories of noninvasive evaluation and preoperative diagnosis, indications for intervention, and then a midsection describing in depth the currently proven and available techniques for intervention. Perhaps the only deficit in this initial section organizationally is the lack of clear natural history studies in the indications section. The chapter’s purpose is to identify comorbid conditions and their evaluation as well as the known indications for peripheral intervention. Despite an extremely thorough review of the evaluation of the vascular patient from the nonperipheral vascular perspective, it would have been very helpful to have further and more detailed review of the indications for arterial reconstructions. For students beginning their studies of vascular disease, the appropriate approach to a vascular patient, including a clear review of natural history studies and remaining controversies in limb salvage, would have been a welcome addition perhaps as a separate and preceding chapter. By necessity this should have included challenging our routine assumptions that all ulcers and apparent rest pain necessarily must undergo arterial reconstruction, without attention to the substratification of those patients including assessment of comorbid conditions such as neuropathy and infection, which can have an impact on long-term healing. Nonetheless, within the confines of standard vascular surgical indications, the clear presentation of perioperative assessment and comorbid risks provides an excellent medical basis for the management of the vascular surgical patient. The chapter on noninvasive evaluation of lower extremity ischemia placed prior to the aforementioned chapter on preoperative assessment provides an excellent overview of diagnostic techniques with perhaps the only omission being that of the utility of vein mapping as well as methods therein. The chapter reflects some of the biases of the authors with regard to the most useful noninvasive test but nonetheless offers an extremely thorough and well-substantiated guide to current noninvasive evaluation. The chapters on current interventional standard techniques (eg, angioplasty, profundaplasty, interposition vein cuffs and collars for prosthetic grafts, reverse and in situ vein bypass, and complex reconstruction) were remarkably free of significant redundancy and technical presentation, reflecting a strong edito-
rial guidance from the primary editor, Dr Mills, and presented outstanding technical presentations as well as informative substantiation for the utility of these respective techniques. The thoroughness of these chapters will render them useful at all stages of a vascular surgical career, and their organization into separate entities facilitated a depth of detail that is frequently lacking in vascular surgical texts. The only criticism, perhaps, of these chapters is their underemphasis of newer techniques in the setting of autogenous bypass (eg, minimal invasive vein harvest techniques and closed in situ bypasses). Although the latter minimally invasive approaches are still in evolution, the current metamorphosis of vascular surgery toward minimal methods suggests the need for a separate treatment of these issues if only to point out current potential shortcomings and potential future development. Finally, the last section of the book provides a hodgepodge of critical issues including intraoperative graft assessment, outcomes from surgery, pathophysiology and detection and treatment of vein graft stenosis, and foot complications in diabetics. Each chapter was helpful and consistent with the standard in the rest of the book. Organizationally, I found the lumping of these chapters together as a potpourri of information imperfect and the setting of the chapter on foot complications in diabetics somewhat out of place. Despite the organizational criticism, the chapters provided critical information as well as practical overview of the need for ongoing relationships with and monitoring of our vascular patients; this is especially well detailed in the excellent chapter on the treatment of vein graft stenosis. Despite the current atmosphere of significant change in vascular surgery, it is important to remember that the vast majority of our patients are still treated by time-tested techniques, which despite their complexity, offer excellent outcomes and alternatives to limb loss. This brief but well-written, well-edited, and complete short text on the issue of the management of chronic ischemia provides extraordinary value in a small package and deserves a place on the shelf of any student of vascular disease. Jonathan Gertler, MD Boston, Mass doi:10.1067/mva.2001.112438
Cardiovascular medicine (CD-ROM) Eric Topol; Philadelphia; 2000; Lippincott-Raven; $275.00. Dr Topol and his colleagues have produced a high-quality textbook of cardiovascular medicine provided in CD-ROM format. Overall, it is a comprehensive and thorough review of the current status of cardiology. It is well organized and well written. The quality of the individual chapters is, in general, high. Each one has useful sections including a glossary, “personal perspectives and controversies,” and “the future.” One can search for topics using key words in a similar fashion to computerized literature search programs. The text is illustrated with echocardiograms, cardiac catheterizations, and intravascular ultrasound images, all of which are provided as real-time images. It goes without saying that this is a novel way of presenting test results, and presenting them in the same format as they are originally performed increases the reader’s understanding of them. There are also audio presentations of auscultations of heart sounds, which I found very helpful. It is much easier to diagnose a friction rub or an S4 once you have heard one.
JOURNAL OF VASCULAR SURGERY/March 2001
669
JOURNAL OF VASCULAR SURGERY March 2001
670 Book Reviews
The text is divided into sections entitled “Preventive Cardiology,” “Clinical Cardiology,” “Electrophysiology and Pacing,” “Cardiovascular Imaging,” “Invasive Cardiology and Surgical Techniques,” “Heart Failure and Transplantation,” and “Vascular Biology and Medicine.” The section addressing prevention has good summaries of the epidemiologic data and clinical trials data that support the relationship between, for example, smoking, hypertriglyceridemia, diabetes mellitus, hypertension, and coronary artery disease. There is a chapter on cardiac rehabilitation that includes a cost-benefit analysis and a chapter on psychosocial issues that includes descriptions of relaxation training, stress management, and behavior modification. There are several interesting chapters on medicoeconomic and medicolegal issues. Substance abuse and athlete’s heart are addressed. The section on invasive techniques covers the new interventional methods, including stenting, atherectomy, laser, and endovascular radiology, thoroughly. Restenosis is addressed, both from a clinical standpoint as well as from the point of basic research to modify endothelial injury and regeneration. The sections dealing with the genetics of cardiovascular disease and the molecular biology have simple, easy-to-understand descriptions of the multitude of new techniques such as for gene therapy, DNA hybridization, and PCR, understandable to those of us not working directly in the field. My only criticism of the textbook is regarding the sections addressing vascular diseases, and thus its utility to vascular surgeons. These sections, for the most part, are not well done, with the exception of Dr Strandness’ chapter on noninvasive vascular imaging. They appear to have been written for an audience of cardiologists and internists, but even with this caveat, they are neither complete nor well organized. For example, the chapter on peripheral arterial occlusive disease does not contain any information about the nonoperative treatment of intermittent claudication, such as exercise, smoking cessation, or cilostazol therapy. The aneurysm chapter does not address endovascular repair in any detail. The chapter on cerebrovascular disease briefly discusses the ACAS and NASCET trials, but with regard to NASCET subjects with 30% to 69% stenosis, it states that “. . . the subgroup continues to be studied.” No mention is made of the findings published in the New England Journal of Medicine in 1998 in which the subgroup with 50% to 69% stenosis was found to benefit from carotid endarterectomy, while those with 30% to 49% stenosis did not.1 If I were a cardiologist, I would acquire this textbook. It is thorough, well organized, and well written, and the real-time images are a wonderful way to present ultrasound and angiographic findings. As a vascular surgeon, I would not buy this book unless I had a specific need for the data provided in the chapters on epidemiology or molecular biology. Because I am interested in the relationship between cardiovascular risk factors and development and progression of peripheral arterial occlusive disease, I found these useful. However, for the practicing surgeon, it probably is not worth the cost of $275 to be entertained by real-time echocardiographic images of the heart.
REFERENCES
Lois Killewich, MD
New Jersey Medical School Newark, NJ
University of Texas Galveston, Tex
1. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes KB, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998;338:1415-25. doi:10.1067/mva.2001.112407
Handbook of coronary care, 6th ed Joseph Alpert, Gary Francis; Philadelphia; 2000; Lippincott Williams & Wilkins; 222 pages; $35.95. The Handbook of Coronary Care by Drs Alpert and Francis is a 222-page pocket guide that outlines strategies for the management of acute myocardial infarction patients requiring coronary care unit admissions. The style of presentation adopted by the authors is to present a short introduction on the topic, treatment recommendations presented in an outline format, and a concise bibliography. The book, therefore, is primarily a laundry list of indications for therapy and recommended treatment algorithms. The target audience who would most benefit from such a format are house officers, who primarily diagnose and treat acute myocardial infarct patients. I therefore believe that vascular surgeons would find little use for this book. The format of the book is its strength and weakness. The concise introductions and treatment recommendations make the handbook a good quick reference for on-the-spot decision making. If readers want more information on a particular topic, the authors refer them to the bibliographies at the end of each chapter for further indepth discussion. As a result, there is little explanation on the pathophysiology of the disease process. I found the majority of the chapters lacking in information pertinent to practicing vascular surgeons. For example, there are numerous beta blockers and calcium channel blockers on the market today. The chapters on these topics gave cursory explanations on the indications for the use of these agents and also discussed the two or three most commonly used drugs. Similarly, the role of cardiac catheterization, percutaneous coronary arterial angioplasty, and cardiac surgery in the management of acute myocardial infarction was discussed in two pages with a third page of references. The best-written chapter in the book was on arrhythmias and their treatment. The diagnosis and management of the various cardiac arrhythmias was clearly written and well suited to the concise format used by the authors. The only chapters of interest to vascular surgeons were the two that discussed the use of lytic agents and platelet glycoprotein IIB/IIIA antagonists. Vascular and endovascular surgeons are using these agents with increasing frequency, yet our familiarity with this class of drugs is not what it should be. Therefore, I found the dosing regimens and protocols on administration useful. This handbook is best suited for house officers managing patients in coronary care units who need quick references on treatment indications and dosages of medications. Vascular surgeons would find little use for this text in their daily management of peripheral vascular patients, and I would not recommend this book to them. Peter Pappas, MD
doi:10.1067/mva.2001.112889
rial guidance from the primary editor, Dr Mills, and presented outstanding technical presentations as well as informative substantiation for the utility of these respective techniques. The thoroughness of these chapters will render them useful at all stages of a vascular surgical career, and their organization into separate entities facilitated a depth of detail that is frequently lacking in vascular surgical texts. The only criticism, perhaps, of these chapters is their underemphasis of newer techniques in the setting of autogenous bypass (eg, minimal invasive vein harvest techniques and closed in situ bypasses). Although the latter minimally invasive approaches are still in evolution, the current metamorphosis of vascular surgery toward minimal methods suggests the need for a separate treatment of these issues if only to point out current potential shortcomings and potential future development. Finally, the last section of the book provides a hodgepodge of critical issues including intraoperative graft assessment, outcomes from surgery, pathophysiology and detection and treatment of vein graft stenosis, and foot complications in diabetics. Each chapter was helpful and consistent with the standard in the rest of the book. Organizationally, I found the lumping of these chapters together as a potpourri of information imperfect and the setting of the chapter on foot complications in diabetics somewhat out of place. Despite the organizational criticism, the chapters provided critical information as well as practical overview of the need for ongoing relationships with and monitoring of our vascular patients; this is especially well detailed in the excellent chapter on the treatment of vein graft stenosis. Despite the current atmosphere of significant change in vascular surgery, it is important to remember that the vast majority of our patients are still treated by time-tested techniques, which despite their complexity, offer excellent outcomes and alternatives to limb loss. This brief but well-written, well-edited, and complete short text on the issue of the management of chronic ischemia provides extraordinary value in a small package and deserves a place on the shelf of any student of vascular disease. Jonathan Gertler, MD Boston, Mass doi:10.1067/mva.2001.112438
Cardiovascular medicine (CD-ROM) Eric Topol; Philadelphia; 2000; Lippincott-Raven; $275.00. Dr Topol and his colleagues have produced a high-quality textbook of cardiovascular medicine provided in CD-ROM format. Overall, it is a comprehensive and thorough review of the current status of cardiology. It is well organized and well written. The quality of the individual chapters is, in general, high. Each one has useful sections including a glossary, “personal perspectives and controversies,” and “the future.” One can search for topics using key words in a similar fashion to computerized literature search programs. The text is illustrated with echocardiograms, cardiac catheterizations, and intravascular ultrasound images, all of which are provided as real-time images. It goes without saying that this is a novel way of presenting test results, and presenting them in the same format as they are originally performed increases the reader’s understanding of them. There are also audio presentations of auscultations of heart sounds, which I found very helpful. It is much easier to diagnose a friction rub or an S4 once you have heard one.
JOURNAL OF VASCULAR SURGERY/March 2001
669
JOURNAL OF VASCULAR SURGERY March 2001
670 Book Reviews
The text is divided into sections entitled “Preventive Cardiology,” “Clinical Cardiology,” “Electrophysiology and Pacing,” “Cardiovascular Imaging,” “Invasive Cardiology and Surgical Techniques,” “Heart Failure and Transplantation,” and “Vascular Biology and Medicine.” The section addressing prevention has good summaries of the epidemiologic data and clinical trials data that support the relationship between, for example, smoking, hypertriglyceridemia, diabetes mellitus, hypertension, and coronary artery disease. There is a chapter on cardiac rehabilitation that includes a cost-benefit analysis and a chapter on psychosocial issues that includes descriptions of relaxation training, stress management, and behavior modification. There are several interesting chapters on medicoeconomic and medicolegal issues. Substance abuse and athlete’s heart are addressed. The section on invasive techniques covers the new interventional methods, including stenting, atherectomy, laser, and endovascular radiology, thoroughly. Restenosis is addressed, both from a clinical standpoint as well as from the point of basic research to modify endothelial injury and regeneration. The sections dealing with the genetics of cardiovascular disease and the molecular biology have simple, easy-to-understand descriptions of the multitude of new techniques such as for gene therapy, DNA hybridization, and PCR, understandable to those of us not working directly in the field. My only criticism of the textbook is regarding the sections addressing vascular diseases, and thus its utility to vascular surgeons. These sections, for the most part, are not well done, with the exception of Dr Strandness’ chapter on noninvasive vascular imaging. They appear to have been written for an audience of cardiologists and internists, but even with this caveat, they are neither complete nor well organized. For example, the chapter on peripheral arterial occlusive disease does not contain any information about the nonoperative treatment of intermittent claudication, such as exercise, smoking cessation, or cilostazol therapy. The aneurysm chapter does not address endovascular repair in any detail. The chapter on cerebrovascular disease briefly discusses the ACAS and NASCET trials, but with regard to NASCET subjects with 30% to 69% stenosis, it states that “. . . the subgroup continues to be studied.” No mention is made of the findings published in the New England Journal of Medicine in 1998 in which the subgroup with 50% to 69% stenosis was found to benefit from carotid endarterectomy, while those with 30% to 49% stenosis did not.1 If I were a cardiologist, I would acquire this textbook. It is thorough, well organized, and well written, and the real-time images are a wonderful way to present ultrasound and angiographic findings. As a vascular surgeon, I would not buy this book unless I had a specific need for the data provided in the chapters on epidemiology or molecular biology. Because I am interested in the relationship between cardiovascular risk factors and development and progression of peripheral arterial occlusive disease, I found these useful. However, for the practicing surgeon, it probably is not worth the cost of $275 to be entertained by real-time echocardiographic images of the heart.
REFERENCES
Lois Killewich, MD
New Jersey Medical School Newark, NJ
University of Texas Galveston, Tex
1. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes KB, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998;338:1415-25. doi:10.1067/mva.2001.112407
Handbook of coronary care, 6th ed Joseph Alpert, Gary Francis; Philadelphia; 2000; Lippincott Williams & Wilkins; 222 pages; $35.95. The Handbook of Coronary Care by Drs Alpert and Francis is a 222-page pocket guide that outlines strategies for the management of acute myocardial infarction patients requiring coronary care unit admissions. The style of presentation adopted by the authors is to present a short introduction on the topic, treatment recommendations presented in an outline format, and a concise bibliography. The book, therefore, is primarily a laundry list of indications for therapy and recommended treatment algorithms. The target audience who would most benefit from such a format are house officers, who primarily diagnose and treat acute myocardial infarct patients. I therefore believe that vascular surgeons would find little use for this book. The format of the book is its strength and weakness. The concise introductions and treatment recommendations make the handbook a good quick reference for on-the-spot decision making. If readers want more information on a particular topic, the authors refer them to the bibliographies at the end of each chapter for further indepth discussion. As a result, there is little explanation on the pathophysiology of the disease process. I found the majority of the chapters lacking in information pertinent to practicing vascular surgeons. For example, there are numerous beta blockers and calcium channel blockers on the market today. The chapters on these topics gave cursory explanations on the indications for the use of these agents and also discussed the two or three most commonly used drugs. Similarly, the role of cardiac catheterization, percutaneous coronary arterial angioplasty, and cardiac surgery in the management of acute myocardial infarction was discussed in two pages with a third page of references. The best-written chapter in the book was on arrhythmias and their treatment. The diagnosis and management of the various cardiac arrhythmias was clearly written and well suited to the concise format used by the authors. The only chapters of interest to vascular surgeons were the two that discussed the use of lytic agents and platelet glycoprotein IIB/IIIA antagonists. Vascular and endovascular surgeons are using these agents with increasing frequency, yet our familiarity with this class of drugs is not what it should be. Therefore, I found the dosing regimens and protocols on administration useful. This handbook is best suited for house officers managing patients in coronary care units who need quick references on treatment indications and dosages of medications. Vascular surgeons would find little use for this text in their daily management of peripheral vascular patients, and I would not recommend this book to them. Peter Pappas, MD
doi:10.1067/mva.2001.112889