Textbook of Endovascular Procedures

Abstract

The authors aptly propose in their preface that endovascular therapy has evolved into a multidisciplinary subspecialty, with contributions to patient care provided by interventional radiologists, vascular surgeons, and invasive cardiologists. The margins defining each of these specialties blur as the techniques of endovascular therapy are acquired by each practitioner; one can foresee the evolution of a “vascular specialist” who draws on training and experience of each of these specialties. The Textbook of Endovascular Procedures reflects the status of endovascular therapy in the new millennium, which is characterized by exponential advances in technology, shifting reimbursement paradigms, and redefinition of heretofore resistant turf boundaries. This diversity of disciplines is reflected not only among the authors (three radiologists and a surgeon) and 94 contributors (radiologists, surgeons, and cardiologists) but also in the organization of chapters. This organization follows the central theme of the text: a discussion of current endovascular management and techniques followed by short commentary on the surgical alternatives and perspectives. The text has six sections, with up to eight chapters per section, for 34 chapters total. In section 1, “The Principles of Endovascular Treatment,” atherosclerosis pathophysiology, basic science of angioplasty and restenosis, interventional pharmacotherapy, metallic stents biology, thrombolysis, complications of endovascular procedures, foreign body retrieval, medicolegal aspects of endovascular procedures, and responsibilities of clinical investigators are the chapter topics; these provide an introduction and foundation for the remainder of the text. In section 2, “Arterial Interventions,” standard topics include angioplasty and stent placement in the aorta and iliac arteries, femoropopliteal arteries, and crural arteries. Of note is chapter 11, “Subintimal Angioplasty,” which is an excellent review of a technique for arterial revascularization. Subsequent chapters cover arterial thrombolysis, renal and visceral arterial intervention, subclavian and axillary arterial interventions, carotid and vertebral arterial interventions, and intraoperative angioplasty. Section 3, “Venous Interventions,” includes chapters on lower-limb venous interventions, upper-limb venous and superior vena cava interventions, inferior vena cava filters, venous access, dialysis fistula interventions, transjugular intrahepatic portosystemic shunts, and pulmonary embolism. Section 4, “Embolization Procedures,” covers the endovascular approach to trauma, visceral arterial embolization, varicocele embolization, embolization of the pelvis in women, embolization of congenital lesions, and chemoembolization. Section 5, “Covered Stents and Endovascular Grafts,” covers endovascular stent-graft repair of occlusive aortoiliac disease, abdominal aortic aneurysm, thoracic aortic aneurysm, iliac arterial aneurysm, arterial dissection, and coarctation. Section 6, “The Future of Endovascular Therapy,” provides a brief look into the future, surveying such important topics as pharmacotherapy and brachytherapy for restenosis. Each of the topics benefits from thorough multidisciplinary analysis and discussion, without the encumbrances of institutional or individual bias seen in other texts. The topics are timely and relevant. Notable are the excellent nontechnical chapters, including chapter 7, “Medicolegal Aspects of Endovascular Procedures and the Obligations of the Clinical Investigator,” which includes a discussion of medical ethics, an often overlooked aspect of medicine. Outstanding technical chapters include chapter 11, “Subintimal Angioplasty,” a procedure that most of us have performed unintentionally without fully appreciating its potential. Many technical insights drawn from the training and experience of the varied authors and contributors are provided. This relatively comprehensive text covers a wide array of topics in respectable detail, yet it is a light read despite its 500 pages. It is a text one could transport comfortably and use as a working reference, unlike many heavier, cumbersome, multivolume treatises on endovascular therapy. This compactness derives in large part from the authors’ efficient use of text, which is not overwhelmed by soon-to-be-irrelevant literature references or by overly specific and redundant discussions of the technique. The drawings, tables, and images are of high quality and reinforce the text. In essence, this balanced text combines the virtues of a didactic reference and the leanness of a technical manual. The Textbook of Endovascular Procedures reflects the state-of-the-art of endovascular therapy. It is an excellent working reference for all who perform endovascular procedures; it will serve the resident, fellow, or practicing physician well.