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Vascular diseases: Surgical & interventional therapy, Volumes I & II
JOURNALOF VASCULARSURGERY Volttme 20, Number 1
Anticoagulation, hemostasis, & blood preservation in cardiovascular surgery Roque Pifarre, MD, Philadelphia, 1993, Hanley & Belfus, Inc., 416 pages, $59. The stated purpose of this volume is to provide a comprehensive review of current knowledge regarding use of anticoagulants, as well as other hemostatic and adjunct drugs in cardiovascular surgery. The book is clinically oriented but provides excellent detailed descriptions of the biochemical mechanisms involved with hemostasis and anticoagulation. Anticoagulation, Hemostasis and Blood Preservation in Cardiovascular Surgery has brought together a variety of
specialists dealing with cardiovascular surgery (surgeons, cardiologists, anesthesiologists, hematologists, pharmacologists, pathologists, and attorneys) to provide a wellwritten book that substantially achieves its stated objective. The book is weighted toward the use of anticoagulants during open heart procedures (25 out of 26 chapters) but provides in-depth coverage of the pharmacology, physiology, and pathology of hemostasis that has relevance for all practitioners who use these drugs. The book is divisible into six primary sections. The first includes introductory chapters providing a foundation of basic pharmacology and physiology for the remainder of the book. The second section contains chapters describing protocols for the use and monitoring of anticoagulant drugs during cardiovascular surgery. The third section presents an overview of anticoagulant and antithrombotic drugs (including the role of aprotonin and desmopressin in cardiovascular surgery) and examines specific complications of anticoagulation. The fourth section covers the use of anticoagulation in highly specialized areas of cardiovascular surgery including artificial hearts, assist devices, cardiopulmonary bypass in children, and substitute heart valves. The fifth section of the book includes a mixture of chapters describing use of anticoagulants during perioperative cardiovascular surgery and peripheral vascular surgery. The last chapters provide insight into the future role of anticoagulation in cardiovascular surgery in terms of new heparin preparations and antithrombotic biomaterials. Interestingly, the last chapter deals with medicolegal aspects of blood transfusions. This chapter is highly detailed and informative. The authors describe in detail why plaintiffs have not fared well against blood banks and suppliers of blood products but have frequently prevailed against hospitals and doctors. This information, although sobering, is useful in our litigious society. I have several criticisms. First, there are repetitively detailed descriptions of the pathways of coagulation and platelet physiology in multiple chapters. This repetition could have been eliminated by more careful editing. Second, the chapter on peripheral vascular disease is brief and written by European vascular specialists (angiologists). A more detailed presentation would have been appropriate. The section on use of anticoagulants in peripheral vascular disease should have been expanded and
Book reviews 161
described by major areas (cerebrovascular disease, aortoiliac disease, etc.) similar to the chapters examining the role of anticoagulants during specific cardiac operations and interventions. In summary, this book is recommended as a comprehensive, up-to-date, and informative source on the use of anticoagulants during cardiovascular surgery. Anyone treating patients undergoing cardiovascular surgery (including vascular surgeons) or using anticoagulants for any reason will benefit from a knowledge of the material contained herein. Smart L Myers, A4D University of Texas SouthwesternMedical Center Dallas, Texas
Vascular diseases: Surgical & interventional therapy, Volumes I & II D. Eugene Strandness, Jr., Arina van Breda, New York, 1994, Churchill Livingstone, Inc., 1269 pages (both volumes), $250 each. Although the bookshelves are weighed down aplenty with volumes describing various aspects of vascular disease at student, practitioner, and professorial level, until now there has been nothing offered to us like these two volumes. The lines above suggest great size and some expense, but they do not indicate great physical and intellectual weight. Both are present in these large-format, impeccably designed books. Professor Strandness has always shown originality in his published books just as his research has shown careful attention to scientific fidelity. Here he has demonstrated prescience in sensing the need to broaden vascular surgery beyond the walls of the surgical suite to encompass interventional radiology. Thus he and Arina van Breda of the George Washington School of Medicine and the Alexandria, Virginia, Hospital have joined their special and considerable skills to plan and produce the first of a new generation of books that will instruct the diagnosis and treatment of our specialty into the next century. Organization of these volumes is tmique. They begin not with anatomy, physiology, nor with diagnostic and interventional techniques, but instead with pathology. And this is not to be pathology of vascular disease but instead the very special pathology of arterial injury and repair. Why not! The editors say it best: "We have come to recognize the hard truth that all forms of vascular reconstruction cause injury, and that injury increases the risk of intimal hyperplasia, restenosis, and thrombosis." Just so. It is the response of the vascular wall to injury that has drastically limited the advance of minimally invasive vascular reconstruction. As one would expect from these editors, physiology of arterial and even of venous abnormalities occupy their particular places in the organization of presentation as does a stand-alone section on diagnostic techniques. However, the authors of these and subsequent sections on acute ischemia, chronic arterial disease, aneurysms, and the
162
JOURNALOF VASCULARSURGERY July 1994
Book reviews
special syndromes of specific cerebrovascular and visceral arterial arborizations are another surprise. Some will ask, who are these people? Those who know will answer, the next generation. There are no old vascular elephants here trundling off to the elephant graveyard. Instead we see younger surgeons, radiologists, and scientists who display their work in the exceedingly extensive reference lists. For the most part, these are at the Associate and Assistant Professor level, and they know their areas very well. One senses a slight imbalance favoring literature knowledge over clinical experience in a few presentations, but this is not troublesome. Attention to inclusion of arteriovenous access, complications of therapy, and even 150 pages on venous disorders
indicate the completeness in planning this publication. One does not complain about the short shrift given to portal hypertension, because this is not really part of the "nuts and boks" of vascular surgery. The publishers deserve a word of thanks for their attention to comfort of the reader. This is observed in intelligent choice of page size, volume heft, font choice and size, and generous use of white space. Vascular surgeons will want these books, interventional radiologists need them, and students will be taught much from their pages.
JohnJ. Bergan, 3¢.D La Jolla, Calif.
Anticoagulation, hemostasis, & blood preservation in cardiovascular surgery Roque Pifarre, MD, Philadelphia, 1993, Hanley & Belfus, Inc., 416 pages, $59. The stated purpose of this volume is to provide a comprehensive review of current knowledge regarding use of anticoagulants, as well as other hemostatic and adjunct drugs in cardiovascular surgery. The book is clinically oriented but provides excellent detailed descriptions of the biochemical mechanisms involved with hemostasis and anticoagulation. Anticoagulation, Hemostasis and Blood Preservation in Cardiovascular Surgery has brought together a variety of
specialists dealing with cardiovascular surgery (surgeons, cardiologists, anesthesiologists, hematologists, pharmacologists, pathologists, and attorneys) to provide a wellwritten book that substantially achieves its stated objective. The book is weighted toward the use of anticoagulants during open heart procedures (25 out of 26 chapters) but provides in-depth coverage of the pharmacology, physiology, and pathology of hemostasis that has relevance for all practitioners who use these drugs. The book is divisible into six primary sections. The first includes introductory chapters providing a foundation of basic pharmacology and physiology for the remainder of the book. The second section contains chapters describing protocols for the use and monitoring of anticoagulant drugs during cardiovascular surgery. The third section presents an overview of anticoagulant and antithrombotic drugs (including the role of aprotonin and desmopressin in cardiovascular surgery) and examines specific complications of anticoagulation. The fourth section covers the use of anticoagulation in highly specialized areas of cardiovascular surgery including artificial hearts, assist devices, cardiopulmonary bypass in children, and substitute heart valves. The fifth section of the book includes a mixture of chapters describing use of anticoagulants during perioperative cardiovascular surgery and peripheral vascular surgery. The last chapters provide insight into the future role of anticoagulation in cardiovascular surgery in terms of new heparin preparations and antithrombotic biomaterials. Interestingly, the last chapter deals with medicolegal aspects of blood transfusions. This chapter is highly detailed and informative. The authors describe in detail why plaintiffs have not fared well against blood banks and suppliers of blood products but have frequently prevailed against hospitals and doctors. This information, although sobering, is useful in our litigious society. I have several criticisms. First, there are repetitively detailed descriptions of the pathways of coagulation and platelet physiology in multiple chapters. This repetition could have been eliminated by more careful editing. Second, the chapter on peripheral vascular disease is brief and written by European vascular specialists (angiologists). A more detailed presentation would have been appropriate. The section on use of anticoagulants in peripheral vascular disease should have been expanded and
Book reviews 161
described by major areas (cerebrovascular disease, aortoiliac disease, etc.) similar to the chapters examining the role of anticoagulants during specific cardiac operations and interventions. In summary, this book is recommended as a comprehensive, up-to-date, and informative source on the use of anticoagulants during cardiovascular surgery. Anyone treating patients undergoing cardiovascular surgery (including vascular surgeons) or using anticoagulants for any reason will benefit from a knowledge of the material contained herein. Smart L Myers, A4D University of Texas SouthwesternMedical Center Dallas, Texas
Vascular diseases: Surgical & interventional therapy, Volumes I & II D. Eugene Strandness, Jr., Arina van Breda, New York, 1994, Churchill Livingstone, Inc., 1269 pages (both volumes), $250 each. Although the bookshelves are weighed down aplenty with volumes describing various aspects of vascular disease at student, practitioner, and professorial level, until now there has been nothing offered to us like these two volumes. The lines above suggest great size and some expense, but they do not indicate great physical and intellectual weight. Both are present in these large-format, impeccably designed books. Professor Strandness has always shown originality in his published books just as his research has shown careful attention to scientific fidelity. Here he has demonstrated prescience in sensing the need to broaden vascular surgery beyond the walls of the surgical suite to encompass interventional radiology. Thus he and Arina van Breda of the George Washington School of Medicine and the Alexandria, Virginia, Hospital have joined their special and considerable skills to plan and produce the first of a new generation of books that will instruct the diagnosis and treatment of our specialty into the next century. Organization of these volumes is tmique. They begin not with anatomy, physiology, nor with diagnostic and interventional techniques, but instead with pathology. And this is not to be pathology of vascular disease but instead the very special pathology of arterial injury and repair. Why not! The editors say it best: "We have come to recognize the hard truth that all forms of vascular reconstruction cause injury, and that injury increases the risk of intimal hyperplasia, restenosis, and thrombosis." Just so. It is the response of the vascular wall to injury that has drastically limited the advance of minimally invasive vascular reconstruction. As one would expect from these editors, physiology of arterial and even of venous abnormalities occupy their particular places in the organization of presentation as does a stand-alone section on diagnostic techniques. However, the authors of these and subsequent sections on acute ischemia, chronic arterial disease, aneurysms, and the
162
JOURNALOF VASCULARSURGERY July 1994
Book reviews
special syndromes of specific cerebrovascular and visceral arterial arborizations are another surprise. Some will ask, who are these people? Those who know will answer, the next generation. There are no old vascular elephants here trundling off to the elephant graveyard. Instead we see younger surgeons, radiologists, and scientists who display their work in the exceedingly extensive reference lists. For the most part, these are at the Associate and Assistant Professor level, and they know their areas very well. One senses a slight imbalance favoring literature knowledge over clinical experience in a few presentations, but this is not troublesome. Attention to inclusion of arteriovenous access, complications of therapy, and even 150 pages on venous disorders
indicate the completeness in planning this publication. One does not complain about the short shrift given to portal hypertension, because this is not really part of the "nuts and boks" of vascular surgery. The publishers deserve a word of thanks for their attention to comfort of the reader. This is observed in intelligent choice of page size, volume heft, font choice and size, and generous use of white space. Vascular surgeons will want these books, interventional radiologists need them, and students will be taught much from their pages.
JohnJ. Bergan, 3¢.D La Jolla, Calif.