Vascular Disease: Diagnostic and Therapeutic Approaches
Vascular Disease: Diagnostic and Therapeutic Approaches is a comprehensive textbook that describes both common and rare vascular disorders facing the practicing clinician. As stated in the Preface, vascular disease is increasing in prevalence with our aging population, and there is a relative lack of qualified clinicians who are trained to diagnose and treat it. Drs Jaff and White are world-renowned experts in the field of vascular medicine, and in editing this book, they provide an ideal blend of vascular medicine and interventional cardiology perspectives. Equally impressive, the editors have assembled a remarkable team of vascular medicine experts and successfully synthesized information in a logical, flowing manner. These contributions distinguish this book from its predecessors by taking the focus away from the approach of a specific medical or surgical specialty and making the book applicable to a wider array of clinicians, trainees, and students. In fact, the book will ideally be read by someone at the beginning stages of medical training, but it provides up-to-date references for those in practice who are looking for answers to questions that arise daily in the care of vascular patients.
The book begins with an excellent overview of the physical examination findings and noninvasive and invasive diagnostic testing options in vascular patients. It then delves into specific vascular disorders, including subclavian and upper-extremity peripheral arterial disease, carotid and vertebral artery disease, aortic diseases, renal artery disease, and lower-extremity peripheral arterial disease. The book concludes with a comprehensive synopsis of nonatherosclerotic arterial diseases, venous disorders, and hypercoagulable states. The chapters are well written, and images, illustrations, and diagrams are used throughout the textbook to represent these vascular conditions superbly.
Despite controversy surrounding the optimal treatment of patients with some forms of vascular disease (eg, carotid stenosis, critical limb ischemia), the authors do an exceptional job of presenting the available literature and the pros and cons for each treatment. In fact, 2 landmark clinical trials, the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) and the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial, are well described, and the authors provide an excellent critical appraisal of the design and results. The authors also are able to describe gene and cell therapy advances (specifically in critical limb ischemia) and provide an accurate interpretation of the possible future use of these biological agents in patients with ischemic diseases. With a few exceptions, the authors avoid describing complicated scoring systems (eg, TransAtlantic InterSociety Consensus classification) and instead anchor their discussion around symptom status and anatomic considerations. All in all, the chapters are excellent references for the reader and are not specifically aimed at the subspecialist, another appealing aspect of the book.
The most powerful part of this book is its ability to incorporate a description of anatomy and physiology with state-of-the-art diagnostic strategies and treatment options. Additional strengths of the book include the editors' choice of providing historical perspectives on treatment choices and indications and/or contraindications for the treatment of specific conditions. Although they are able to include results from many randomized clinical studies in the field, the authors were not able to maintain a fully up-to-date account of newly reported findings in vascular disease (an inherent limitation of all textbooks). Some critics may also state that the book's focus on endovascular therapy overshadows a mainstay of the treatment of vascular patients, surgical revascularization. Nevertheless, the treatment of vascular patients has shifted dramatically to an endovascular approach, and the book captures this extremely well.
In summary, Drs Jaff and White and their coauthors should be commended for their contribution to the vascular literature. The book is able to introduce concepts for the first-time reader and to comprehensively cover the main aspects of vascular medicine and endovascular medicine for the experienced physician. It will be a valuable commodity for practicing clinicians, trainees, and students alike.
Manesh R. Patel, MD
W. Schuyler Jones, MD
Department of Medicine
Division of Cardiology
Duke University Medical Center
- © 2012 American Heart Association, Inc.