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Peripheral Arterial Disease: Diagnosis and Treatment
Book Reviews
Pathways of Care in Vascular Surgery
Jonathan D. Beard, Shelagh Murray (eds.). Shropshire, UK: tfm Publishing, 2002. ISBN: 1-90337-809-5. Pages: 372. Price: $45.00. Pathways of Care in Vascular Surgery is based on a symposium held in Sheffield, U.K., in June 2002, by a joint vascular research group, and aims to provide an evidenced-based approach to vascular surgery. This, in itself, is a Herculean task, given the paucity of scientific evidence and outcomes research in many areas of vascular surgery. A considerable effort is nonetheless made to categorize evidence in almost every particular area of vascular surgery. A great deal of variation exists, however, regarding how much evidence exists to justify treatment plans and pathways of care in vascular surgery. The first chapter, for instance, ‘‘Nurse Led Claudication Clinics,’’ is lacking in evidence-based support and cites only one publication describing patient satisfaction with such nurse-led clinics. This chapter seems to have little relevance to vascular surgery practice in the United States, since it would be virtually impossible to build a business plan around such clinics. Payment, though not apparently an issue in the U.K. system, would prohibit such clinics in the United States and some other countries since insurers (and Medicare) would not pay for a nurse-led claudication clinic. In fact, throughout the book, many of the individual author’s references to government programs or policies do not apply outside of the U.K., such as in the chapters ‘‘Day Case, Angiography and Intervention,’’ ‘‘Medical-Legal and Risk Management Issues,’’ and ‘‘National Service Frameworks.’’ The book is generally well written, but many of the chapters do not present a significant amount of new information and some chapters could not conceal author bias. The chapter ‘‘Vascular Access for Hemodialysis’’ had a great deal of useful information. The author emphasizes remarkably high rates of primary arterial venous fissures and the avoidance of conduit grafts. Unfortunately, little information is provided on this aspect of hemodialysis access, which, for those of us forced to labor at sustaining patients who require artificial graft access, was a bit disappointing. A more balanced view would provide more information about this common alternative.
Ó Annals of Vascular Surgery Inc.
Initially, I did not have a positive reaction to this book, but the more I read, the more I became intrigued. I suspect my reaction was in response to clear-cut hard data that served to emphasize where my own clinical practice was based upon opinion rather than real evidence. Perhaps it is hard to admit that our ‘‘well-accepted’’ graft surveillance program has no demonstrated evidence in improvement in limb salvage rate, for example. Some of this may be hard for a practicing vascular surgeon to accept. Most of the book is succinctly written, uniform in style and presentation, and therefore very little duplication appears in the text as a whole. (This is not an insignificant achievement in a text of this type.). There are concise summaries of the problem being discussed together with a summary and grading of the available evidence. The book does have a role for the clinical vascular surgeons interested in examining and re-examining their practices in the light of available evidence. Clinical researchers, particularly those interested in outcome-based research, will find this book of use. This book will have a spot on my bookshelf. It is likely I will use it as a quick reference when a question on any particular topic comes up. DOI: 10.1007/s10016-003-0007-0 Published online: 25 April 2003 Michael A. Ricci, MD Peripheral Arterial Disease: Diagnosis and Treatment
Jay D. Coffman, Robert T. Eberhardt (eds.). Totowa, NJ: Humana Press, 2002. ISBN: 1-58829-052-2. Pages: 368. Price: $129.50. This is a comprehensive textbook dedicated to the epidemiology, evaluation, risk factor identification and management, and treatment of arterial diseases affecting the lower extremity. Co-edited by two well-recognized experts in the field of vascular medicine, this text is a timely addition to the library of all vascular specialists, regardless of specialty. The book is appropriately dedicated to two giants in the field of vascular disease diagnosis and treatment—D. Eugene Strandness, MD, and Jeffrey Isner, MD. The initial chapter defines risk factors for atherosclerosis in general, and spends a considerable amount of time on the expanding role of nitric oxide and endothelial dysfunction. This chapter would have been more valuable for the reader if more text were spent on the 345
346 Book reviews
impact of hyperhomocysteinemia on the etiology and pathogenesis of accelerated atherosclerosis. The subsequent chapter nicely reviews classic and novel risk factors for peripheral arterial disease. The section on clinical evaluation is excellent, and describes the various historical clues and examination maneuvers available to the clinician. However, there is overlap between these two chapters regarding the association between PAD and other atherosclerotic diseases. The section by Dr. Strandness is masterful; however, images of test performance and of duplex ultrasound scans would have made this even more powerful. This chapter demonstrates the profound impact Dr. Strandness has had on our ability to diagnose and categorize arterial diseases, and is a highlight of the textbook. Dr. Kaufman’s section on other imaging modalities, including contrast arteriography, MRA, and CTA, are well written and very informative. The section on postprocessing is a bit long for this audience. The textbook then enters into the treatment segment, and begins with the management of critical limb ischemia, which is well written and current. However, significant overlap exists between this chapter, Chapter 13, and the vascular laboratory chapter. Excellent rationale for performance of modern vascular surgical procedures is demonstrated, but there is no clear reason for two separate chapters on surgical therapy of PAD, unless these were designed to separately discuss surgical therapy for critical limb ischemia and intermittent claudication. The section on diagnosis and management of acute limb ischemia is one of the finest published in modern medicine, and makes this textbook worth purchasing for anyone interested in vascular disease. The author takes a very complex subject and makes the data easily interpretable. The chapter on exercise therapy is written by one of the foremost experts in this field, and nicely describes the actual structure and operation of a peripheral exercise rehabilitation program. Risk factor modification is reviewed nicely by Dr. Mohler, providing significant guidance to the clinician on
Annals of Vascular Surgery
the appropriate strategies for this important cornerstone of PAD treatment. The section on pharmacotherapy is well written and quite current. Appropriately, most time is spent on the two agents approved for use in the United States. The review of other agents either approved outside the U.S. or in clinical trials is well done. The section on gene therapy is very well written by two experts in the field. It would have been helpful for the authors to have provided an update on clinical trials of angiogenic agents in intermittent claudication. The chapter on endovascular therapy is current and comprehensive. However, given the scope of the textbook limited to diseases of the lower extremity arteries, the sections on carotid and renal endovascular interventions should have been excluded. The sections on cardiac evaluation of the vascular patient and management of the diabetic foot are very well done, and are welcome additions to this text. These topics are often ignored or glossed over in standard vascular therapy texts, and these two chapters provide important insights into these common clinical issues. With the expanding knowledge of atherosclerosis in women, Dr. Gerhard provides an excellent overview of unique aspects of non-coronary vascular disease in this patient population. The final sections discuss important, yet less common, disorders affecting the peripheral arteries, including atheromatous embolization, thromboangiitis obliterans, and large vessel vasculitis. All sections are quite comprehensive and offer insights into diagnostic clues and treatment options. This textbook of Peripheral Arterial Disease is well organized and well written. It represents an important addition to the library of the vascular specialist and those clinicians interested in vascular diseases of the lower extremity arteries. DOI: 10.1007/s10016-003-0008-z Published online: 25 April 2003 Michael R. Jaff, DO, FACP, FACC
Pathways of Care in Vascular Surgery
Jonathan D. Beard, Shelagh Murray (eds.). Shropshire, UK: tfm Publishing, 2002. ISBN: 1-90337-809-5. Pages: 372. Price: $45.00. Pathways of Care in Vascular Surgery is based on a symposium held in Sheffield, U.K., in June 2002, by a joint vascular research group, and aims to provide an evidenced-based approach to vascular surgery. This, in itself, is a Herculean task, given the paucity of scientific evidence and outcomes research in many areas of vascular surgery. A considerable effort is nonetheless made to categorize evidence in almost every particular area of vascular surgery. A great deal of variation exists, however, regarding how much evidence exists to justify treatment plans and pathways of care in vascular surgery. The first chapter, for instance, ‘‘Nurse Led Claudication Clinics,’’ is lacking in evidence-based support and cites only one publication describing patient satisfaction with such nurse-led clinics. This chapter seems to have little relevance to vascular surgery practice in the United States, since it would be virtually impossible to build a business plan around such clinics. Payment, though not apparently an issue in the U.K. system, would prohibit such clinics in the United States and some other countries since insurers (and Medicare) would not pay for a nurse-led claudication clinic. In fact, throughout the book, many of the individual author’s references to government programs or policies do not apply outside of the U.K., such as in the chapters ‘‘Day Case, Angiography and Intervention,’’ ‘‘Medical-Legal and Risk Management Issues,’’ and ‘‘National Service Frameworks.’’ The book is generally well written, but many of the chapters do not present a significant amount of new information and some chapters could not conceal author bias. The chapter ‘‘Vascular Access for Hemodialysis’’ had a great deal of useful information. The author emphasizes remarkably high rates of primary arterial venous fissures and the avoidance of conduit grafts. Unfortunately, little information is provided on this aspect of hemodialysis access, which, for those of us forced to labor at sustaining patients who require artificial graft access, was a bit disappointing. A more balanced view would provide more information about this common alternative.
Ó Annals of Vascular Surgery Inc.
Initially, I did not have a positive reaction to this book, but the more I read, the more I became intrigued. I suspect my reaction was in response to clear-cut hard data that served to emphasize where my own clinical practice was based upon opinion rather than real evidence. Perhaps it is hard to admit that our ‘‘well-accepted’’ graft surveillance program has no demonstrated evidence in improvement in limb salvage rate, for example. Some of this may be hard for a practicing vascular surgeon to accept. Most of the book is succinctly written, uniform in style and presentation, and therefore very little duplication appears in the text as a whole. (This is not an insignificant achievement in a text of this type.). There are concise summaries of the problem being discussed together with a summary and grading of the available evidence. The book does have a role for the clinical vascular surgeons interested in examining and re-examining their practices in the light of available evidence. Clinical researchers, particularly those interested in outcome-based research, will find this book of use. This book will have a spot on my bookshelf. It is likely I will use it as a quick reference when a question on any particular topic comes up. DOI: 10.1007/s10016-003-0007-0 Published online: 25 April 2003 Michael A. Ricci, MD Peripheral Arterial Disease: Diagnosis and Treatment
Jay D. Coffman, Robert T. Eberhardt (eds.). Totowa, NJ: Humana Press, 2002. ISBN: 1-58829-052-2. Pages: 368. Price: $129.50. This is a comprehensive textbook dedicated to the epidemiology, evaluation, risk factor identification and management, and treatment of arterial diseases affecting the lower extremity. Co-edited by two well-recognized experts in the field of vascular medicine, this text is a timely addition to the library of all vascular specialists, regardless of specialty. The book is appropriately dedicated to two giants in the field of vascular disease diagnosis and treatment—D. Eugene Strandness, MD, and Jeffrey Isner, MD. The initial chapter defines risk factors for atherosclerosis in general, and spends a considerable amount of time on the expanding role of nitric oxide and endothelial dysfunction. This chapter would have been more valuable for the reader if more text were spent on the 345
346 Book reviews
impact of hyperhomocysteinemia on the etiology and pathogenesis of accelerated atherosclerosis. The subsequent chapter nicely reviews classic and novel risk factors for peripheral arterial disease. The section on clinical evaluation is excellent, and describes the various historical clues and examination maneuvers available to the clinician. However, there is overlap between these two chapters regarding the association between PAD and other atherosclerotic diseases. The section by Dr. Strandness is masterful; however, images of test performance and of duplex ultrasound scans would have made this even more powerful. This chapter demonstrates the profound impact Dr. Strandness has had on our ability to diagnose and categorize arterial diseases, and is a highlight of the textbook. Dr. Kaufman’s section on other imaging modalities, including contrast arteriography, MRA, and CTA, are well written and very informative. The section on postprocessing is a bit long for this audience. The textbook then enters into the treatment segment, and begins with the management of critical limb ischemia, which is well written and current. However, significant overlap exists between this chapter, Chapter 13, and the vascular laboratory chapter. Excellent rationale for performance of modern vascular surgical procedures is demonstrated, but there is no clear reason for two separate chapters on surgical therapy of PAD, unless these were designed to separately discuss surgical therapy for critical limb ischemia and intermittent claudication. The section on diagnosis and management of acute limb ischemia is one of the finest published in modern medicine, and makes this textbook worth purchasing for anyone interested in vascular disease. The author takes a very complex subject and makes the data easily interpretable. The chapter on exercise therapy is written by one of the foremost experts in this field, and nicely describes the actual structure and operation of a peripheral exercise rehabilitation program. Risk factor modification is reviewed nicely by Dr. Mohler, providing significant guidance to the clinician on
Annals of Vascular Surgery
the appropriate strategies for this important cornerstone of PAD treatment. The section on pharmacotherapy is well written and quite current. Appropriately, most time is spent on the two agents approved for use in the United States. The review of other agents either approved outside the U.S. or in clinical trials is well done. The section on gene therapy is very well written by two experts in the field. It would have been helpful for the authors to have provided an update on clinical trials of angiogenic agents in intermittent claudication. The chapter on endovascular therapy is current and comprehensive. However, given the scope of the textbook limited to diseases of the lower extremity arteries, the sections on carotid and renal endovascular interventions should have been excluded. The sections on cardiac evaluation of the vascular patient and management of the diabetic foot are very well done, and are welcome additions to this text. These topics are often ignored or glossed over in standard vascular therapy texts, and these two chapters provide important insights into these common clinical issues. With the expanding knowledge of atherosclerosis in women, Dr. Gerhard provides an excellent overview of unique aspects of non-coronary vascular disease in this patient population. The final sections discuss important, yet less common, disorders affecting the peripheral arteries, including atheromatous embolization, thromboangiitis obliterans, and large vessel vasculitis. All sections are quite comprehensive and offer insights into diagnostic clues and treatment options. This textbook of Peripheral Arterial Disease is well organized and well written. It represents an important addition to the library of the vascular specialist and those clinicians interested in vascular diseases of the lower extremity arteries. DOI: 10.1007/s10016-003-0008-z Published online: 25 April 2003 Michael R. Jaff, DO, FACP, FACC