PAGE 124 JOURNAL OF VASCULAR NURSING SEPTEMBER 2011www.jvascnurs.net

Clinical

Column

Kathleen Rich, PhD, RN, CCNS

Book Review: Vascular disease diagnostic and therapeuticapproaches. Edited by Michael R. Jaff and Christopher J. White(38 contributors). Minneapolis, MN: Cardiotext Publishing,LLC. 582 pp., 2011. $169.00 hardcover (ISBN: 9781935395164)

The care of patients experiencing vascular disease is a dy-namic and evolving field. Organized into 8 major sections orparts, this text is intended to be an introductory, comprehensiveguide in the diagnosis and care of the vascular patient. Thebook targets those practicing physicians who are not vascularspecialists. The parts are well written and presented in an easy-to-understand, logical format. The disease sections are organizedin a similar manner; each beginning with definitions, clinical pre-sentation, pathophysiology and diagnosis, and ending with ther-apeutic management options. Available research findings aresummarized. Surgical and endovascular therapies are presentedif appropriate with the focus on percutaneous interventions.

Part 1 discusses the evaluation of a patient with a peripheralvascular problem. The emphasis in this section is on the generalhistory and physical examination. Differentiation of pain, ulcersand edema among the arterial, venous and neurotrophic entities isconcisely described both in the text and in several summarytables. The diseases that need to be addressed in the differentialdiagnosis of limb pain include orthopedic and neurogenic etiol-ogies, both often overlooked in other references. The vascularexamination incorporates multiple clear color pictures and illus-trations that show examples of vascular physical findings.

The diagnosis of peripheral artery disease (PAD) is the focusof Part 2. Subdivided into two chapters, the first chapter targetsnoninvasive diagnostic tests. Physiological tests include theAnkle-Brachial Index (ABI), exercise treadmill test, segmentallimb pressures and pulse volume recordings. Noninvasive ana-tomic tests discussed are duplex ultrasound, magnetic resonanceangiography (MRA) and computed tomography angiography(CTA). Each test is explained, comparing the findings for the nor-mal patient with results seen in a patient with PAD. The otherchapter in Part 2 reviews peripheral vascular angiography. Thearterial system is presented in segments. Each vascular segmentor area begins with an anatomy review and then proceeds into

From the IU Health La Porte Hospital, Patient Care Services,Chesterton, Indiana.

Corresponding author: Kathleen Rich, PhD, RN, CCNS, IUHealth La Porte Hospital, Patient Care Services, 1307 ParkRoad, Chesterton, Indiana 46304 (E-mail: e.rich@comcast.net).

J Vasc Nurs 2011;29:124-5.

1062-0303/$36.00

Copyright � 2011 by the Society for Vascular Nursing, Inc.

doi:10.1016/j.jvn.2011.05.001

a technical description of the appropriate diagnostic catheters,guidewires and approaches to use for particular vessels. Thechapter ends with a summary of angiogram complications. Thereis a nice synopsis of the conflicting evidence regarding options toprevent contrast-induced nephropathy. Thromboembolic events,however, were missing from the angiography complication list.

Part 3 deals with the aortic arch and supraclavicular arterydisease. The chapters in this section focus on subclavian andupper extremity disease, extracranial carotid artery disease, ver-tebrobasilar insufficiency and hemodialysis access intervention.The images continue to be of high quality. Medical managementand procedural complications are described in varying details foreach vascular disease entity. The chapter on extracranial carotiddisease presents the available trial data comparing carotid endar-terectomy (CEA) with carotid stenting. The technical aspects ofcarotid stents are limited to a discussion of embolic protectiondevices. Although stroke complication rates were presented forCEA and carotid stenting, no other complications were listedfor either treatment option. The chapter on vertebrobasilar insuf-ficiency concentrates on vertebral artery stenosis, including clin-ical manifestations and diagnosis, as well as surgical andendovascular management. The emphasis in the hemodialysis ac-cess chapter is on recognition of the failing fistula or graft and theappropriate medical management. As endovascular therapy is themost common initial intervention for the problematic dialysis ac-cess, there is an extensive discussion of the procedural issues in-volved in re-establishing flow with practical information for theoperator.

Part 4 examines vascular diseases of the aorta, as well as vis-ceral and renal arteries. Included are chapters on the thoracicaorta, aneurysmal disease of the abdominal aorta, chronic mesen-teric ischemia and renal artery disease. The aorta chapters exam-ine aneurysmal disease (both thoracic and abdominal aorta) andaortic dissection (thoracic). Differentiation of aneurysm expan-sion rates based on location and comorbidities is well summa-rized. The images and figures support the text. Furthermore,both open and endovascular repair are reviewed, and the compli-cations that may occur with endovascular aneurysm repair arebriefly explained. The discussion of endoleaks focuses uponTypes I, II and III, without mentioning Type IV. The chapteron chronic mesenteric ischemia includes the signs and symptomsalong with the appropriate therapies. Although mesenteric ve-nous thrombosis is discussed in the chapter on uncommon venousdisorders, information on acute mesenteric ischemia is not in-cluded. Nevertheless, the care and endovascular treatment ofthe patient with renal artery stenosis is concisely described.

Part 5 examines the patient with lower-extremity arterialdisease. This section encompasses acute limb ischemia, aor-toilliac occlusive disease, femoropopliteal disease, chronic crit-ical limb ischemia and access-site complications resulting fromendovascular procedures. The chapter on acute limb ischemiaprovides a straightforward medical management algorithmbased on Rutherford’s classification. Research is summarizedin detail regarding the various interventional outcomes in acute

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limb ischemia, but the chapter on aortoiliac occlusive disease isbrief. The endovascular therapy features clinical issues in-volved with isolated infrarenal aortic angioplasty and/or stent-ing. Iliac artery endovascular procedures are not mentioned,but the various standard open surgical interventions for aortoil-iac occlusive disease are presented. Surgical outcomes are lim-ited to reports on graft patency rates and mortality. The chapterson femoropopliteal disease and chronic limb ischemia havesome redundancy in the description of diagnostic tests used,as previously discussed in Part 2. Medical, surgical and endo-vascular therapies are explored along with a report of emergingtreatments. The emphasis is on lower-extremity atheroscleroticocclusive disease. The vascular access complication chapter isa well-written review in assessing for, preventing and treatingfemoral, radial and popliteal artery access-site problems. Thereis a slight overlap of the content in this chapter and the periph-eral angiography complications described in Part 2. Bleedingcomplications, pseudoaneurysm and thromboembolic events,among others, are elaborated on as well as the appropriatetherapies.

Nonatherosclerotic artery diseases are summarized in Part 6.These include thromboangiitis obliterans (Burger’s Disease),systemic vasculitides, vasospastic diseases and fibromusculardysplasia. Five systemic vasculotides are examined: Takayasu’sarteritis, giant cell arteritis, polyarteritis nodosa, Wegener’s gran-ulomatosis and hypersensitivity vasculitis. Vasospastic diseasesinclude Raynaud’s phenomenon, livedo reticularis and acrocy-naosis. The pathogenesis of each disease is interesting to read,and the treatment option explanations are succinctly written.

Part 7 discusses venous disease, specifically deep venousthrombosis (DVT) and pulmonary embolism (PE), superiorvena cava syndrome, uncommon venous disorders and chronicvenous insufficiency (CVI). The diagnostic tests and associatedfindings are discussed in detail for PE and DVT; however, theclinical presentation for each disease is not discussed. Pharma-cologic and mechanical therapies are detailed. Complications

of DVT, such as development of CVI and phlegmasia ceruleadolens, are not mentioned. Of note, the authors reference the2004 ACCP Conference recommendations for venous thrombo-embolic disease, rather than the updated 2008 ACCP guidelines.The discussions of uncommon venous disorders include congen-ital (Klippel-Trenaunay, Parkes-Weber and Kasabach-MerrittSyndromes, among others) along with acquired disorders (cere-bral venous sinus thrombosis, mesenteric venous thrombosisand Budd-Chiari Syndrome). Each of these disease entities isdiscussed and the sections include the respective managementoptions. The chapter on CVI is the most extensive, with numer-ous tables, illustrations and figures to support the content. Thesections about the surgical and endovenous therapies for CVIare comprehensive and very readable.

Part 8 examines hypercoagulable disorders and several mis-cellaneous vascular diseases. The hypercoagulable entities com-prise inherited antithrombin, protein C and protein S deficienciesalong with Factor V Leiden and prothrombin gene mutations.Acquired hypercoagulable states consist of antiphospholipid syn-drome and heparin-induced thrombocytopenia. Various entitiesthat have a propensity to act as procoagulants are mentioned,such as cancer, pregnancy and hormonal therapy. The miscella-neous vascular chapter covers environmental vascular disordersnot often included in vascular texts, such as frostbite, erythrome-lalgia and pernio (chilblains). Hereditary disorders are also fo-cused on, such as Marfan’s syndrome and Ehlers-Danlossyndrome Type IV.

This book is a good reference for the nonvascular diseasephysician and those physicians with an interest in the endovascu-lar therapies implemented in various vascular diseases. The manyfigures, illustrations and images throughout are a major strength.Including a discussion on vascular trauma and postproceduralcare (both surgical and endovascular) would enhance the text.For both vascular and nonvascular specialty nurses, it providesan excellent source of information relative to the pathophysiol-ogy, clinical presentation and management of vascular disorders.