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Modern vascular grafts
B O O K REVIEWS George Johnson, Jr., M.D., Book Review Section Editor
Diagnostic techniques and assessment procedures in vascular surgery Roger M. Greenhalgh, ed. London, 1985, Grune & Stratton, Ltd., 505 pages, S69.00. Each June, the British have the tradition of Heuley and Wimbledon and now in the late spring England also has Roger Greenhalgh's Vascular Symposia. Each symposium focuses on a broad area of vascular surgery, and in this volume the subject is the various diagnostic tests used in vascular surgery. The text is divided into principles of investigation and specific areas of evaluation. In the first segment the basic concepts of Doppler ultrasound, ultrasonic imaging, and arteriography are clearly discussed with excellent graphic accompaniment. Next follow three chapters on different methods for the assessment of both cardiac function and risk. The chapter by Nicolaides and his associates on assessment of cardiac risk is quite good, but most U.S. vascular surgeons now would favor dipyridamole-thallium testing for cardiac screening rather than the logistically cumbersome and often equivocal ECG stress test induced by upper extremity exercise. The chapter on cardiovascular monitoring by Kox was a little simplistic for this type of book and lacked supporting data and current references. In the next section on cerebral vascular disease, the role of duplex scanning in assessing the degree of carotid stenosis is discussed in detail, but there is little information on the description of plaque morphology by B-mode ultrasound which is of increasing importance to the vascular surgeon. For the occasional user of intraoperative completion arteriography, Courbier clearly outlines both the method and interpretation criteria from his extensive experience. The accompanying arteriograms illustrate the technique well. The chapter by Ehrenfeld and Reilly on renal revascularization was not only a careful, honest report from a center with extensive experience, but it also contains an excellent review of data from other large centers. Mthough in their collective review the authors emphasize the possibility of an 85% improvement in patients with renovascular hypertension, they also point out the potential associated mortality rate of more than 8% for combined aortic and renal vascular surgery. The final section of the book deals with venous disorders. Darke's review of approximately 600 patients who underwent phlebography for chronic venous insufficiency provides a wealth of information correlating venous anatomy with the clinical state. Finally, Flanagan and Cranley's experience with more than 1600 B-mode ultrasound scans for evaluation of acute venous disease supports their contention that it might be the future diagnostic procedure of choice for deep venous thrombosis. 504
Diagnostic Techniques and Assessment Proceduresfor Vascular Surgery by Greenhalgh is an up-to-date compendium for the practicing vascular surgeon. Because of the excellent organization of the symposium and tight publishing deadlines, recent data are available to the reader, which cannot usually be found in standard textbooks of vascular surgery. This text supplies valuable new information for the surgical resident, vascular fellow, and practicing surgeon. ~ T. F. O'Donnell, Jr., MJ). New England Medical Center
Modern vascular grafts Philip N. Sawyer. New York, 1987, McGraw-Hill Book Company, 326 pages, $50.00. This multiauthored volume, capably edited by Dr. Sawyer, provides us with an interesting overview of the present array of vascular graft materials. The reader is left with the appropriate conclusion that autogenous saphenous vein remains the best conduit (aside from the less frequently employable autogenous artery) and that, in distal lower extremity revascularization, the in situ venous bypass seems the procedure of choice. Most chapters are written by experts in their fields and the unsophisticated reader must be wary of a hint of advocacy for particular theories or prostheses, which accompany otherwise excellent data by these authors. Some chapters are scholarly and detailed reviews, which crystallize and refresh the thinking of even those physicians experienced in vascular surgery. One can review long-advocated concepts on the importance of electroneg~ ativity in inhibiting thrombosis, ably summarized exper~ mental work by Lyman and his group on the importance of compliance, and an excellent review on in situ vein grafts by Leather et al. A compressed, but quite complete, summary on infected grafts by Goldstone is well worth reading and re-reading, whereas a chapter on present and future graft needs, from the manufacturer's point of view, provides us with statistical information not heretofore readily available (at least to this reviewer). This volume also tells us that the practical implementation of endothelial seeding may be a bit nearer and the practical simulation of the elastic, compliant properties of a normal artery may be a bit closer, but that the ideal prosthesis still eludes us. It does provide a good review of the current state of the art, with appropriate hints as to which ongoing research endeavors may lead us to the ;¢ gra f t , of tomorrow." Norman Rosenberg, M.D. The Robert Wood Johnson Medical School
Diagnostic techniques and assessment procedures in vascular surgery Roger M. Greenhalgh, ed. London, 1985, Grune & Stratton, Ltd., 505 pages, S69.00. Each June, the British have the tradition of Heuley and Wimbledon and now in the late spring England also has Roger Greenhalgh's Vascular Symposia. Each symposium focuses on a broad area of vascular surgery, and in this volume the subject is the various diagnostic tests used in vascular surgery. The text is divided into principles of investigation and specific areas of evaluation. In the first segment the basic concepts of Doppler ultrasound, ultrasonic imaging, and arteriography are clearly discussed with excellent graphic accompaniment. Next follow three chapters on different methods for the assessment of both cardiac function and risk. The chapter by Nicolaides and his associates on assessment of cardiac risk is quite good, but most U.S. vascular surgeons now would favor dipyridamole-thallium testing for cardiac screening rather than the logistically cumbersome and often equivocal ECG stress test induced by upper extremity exercise. The chapter on cardiovascular monitoring by Kox was a little simplistic for this type of book and lacked supporting data and current references. In the next section on cerebral vascular disease, the role of duplex scanning in assessing the degree of carotid stenosis is discussed in detail, but there is little information on the description of plaque morphology by B-mode ultrasound which is of increasing importance to the vascular surgeon. For the occasional user of intraoperative completion arteriography, Courbier clearly outlines both the method and interpretation criteria from his extensive experience. The accompanying arteriograms illustrate the technique well. The chapter by Ehrenfeld and Reilly on renal revascularization was not only a careful, honest report from a center with extensive experience, but it also contains an excellent review of data from other large centers. Mthough in their collective review the authors emphasize the possibility of an 85% improvement in patients with renovascular hypertension, they also point out the potential associated mortality rate of more than 8% for combined aortic and renal vascular surgery. The final section of the book deals with venous disorders. Darke's review of approximately 600 patients who underwent phlebography for chronic venous insufficiency provides a wealth of information correlating venous anatomy with the clinical state. Finally, Flanagan and Cranley's experience with more than 1600 B-mode ultrasound scans for evaluation of acute venous disease supports their contention that it might be the future diagnostic procedure of choice for deep venous thrombosis. 504
Diagnostic Techniques and Assessment Proceduresfor Vascular Surgery by Greenhalgh is an up-to-date compendium for the practicing vascular surgeon. Because of the excellent organization of the symposium and tight publishing deadlines, recent data are available to the reader, which cannot usually be found in standard textbooks of vascular surgery. This text supplies valuable new information for the surgical resident, vascular fellow, and practicing surgeon. ~ T. F. O'Donnell, Jr., MJ). New England Medical Center
Modern vascular grafts Philip N. Sawyer. New York, 1987, McGraw-Hill Book Company, 326 pages, $50.00. This multiauthored volume, capably edited by Dr. Sawyer, provides us with an interesting overview of the present array of vascular graft materials. The reader is left with the appropriate conclusion that autogenous saphenous vein remains the best conduit (aside from the less frequently employable autogenous artery) and that, in distal lower extremity revascularization, the in situ venous bypass seems the procedure of choice. Most chapters are written by experts in their fields and the unsophisticated reader must be wary of a hint of advocacy for particular theories or prostheses, which accompany otherwise excellent data by these authors. Some chapters are scholarly and detailed reviews, which crystallize and refresh the thinking of even those physicians experienced in vascular surgery. One can review long-advocated concepts on the importance of electroneg~ ativity in inhibiting thrombosis, ably summarized exper~ mental work by Lyman and his group on the importance of compliance, and an excellent review on in situ vein grafts by Leather et al. A compressed, but quite complete, summary on infected grafts by Goldstone is well worth reading and re-reading, whereas a chapter on present and future graft needs, from the manufacturer's point of view, provides us with statistical information not heretofore readily available (at least to this reviewer). This volume also tells us that the practical implementation of endothelial seeding may be a bit nearer and the practical simulation of the elastic, compliant properties of a normal artery may be a bit closer, but that the ideal prosthesis still eludes us. It does provide a good review of the current state of the art, with appropriate hints as to which ongoing research endeavors may lead us to the ;¢ gra f t , of tomorrow." Norman Rosenberg, M.D. The Robert Wood Johnson Medical School