Those
who have been following the Brazilian vascular surgery scene over
the last 20 years will certainly remember quite a few fashions that
have dominated our meetings. Who can forget in situ bypass,
"chelation" therapy, vasculogenic impotence, "rotablator"
and other forms of laser angioplasty, retroperitoneal approach to
the aorta, eversion carotid endarterectomy, laser sclerotherapy
and so many others? Some of these fads have vanished without leaving
a trace; others were accepted as real scientific advances and have
been incorporated into the diagnostic and therapeutic arsenal of
our specialty.
The latest rage is endovascular surgery. For the last 4 or 5 years,
this issue has gained far more attention and time in our meetings
than its practical importance for Brazilian vascular surgeons would
justify. We do not know yet how much endovascular surgery will change
our practice in the future. However, all of us have been compelled
to learn these new techniques because the social pressure of fashion
so demands. Whether vascular surgeons like it or not, learning the
basic technical aspects of endovascular surgery is becoming a social
imposition. Vascular surgeons will hardly find a better introduction
to endovascular surgery than the book Endovascular Skills.1
This small manual on interventional radiology and endovascular surgery
techniques covers the whole spectrum of basic techniques for endovascular
management in approximately 200 pages. The book has 16 chapters,
ordered in increasing levels of complexity. At the beginning, it
presents some concepts on minimally invasive treatment of vascular
lesions. It goes on to describe didactically the techniques of arterial
puncture, the use of guidewires and sheaths, the choice of catheters
and stent placement. Throughout the text, it also presents many
"tips" and bits of advice on how to avoid complications
and how to deal with them in case they occur.
The author, Peter A. Schneider, is a professor of vascular surgery
at the University of Hawaii. One of the positive aspects of the
book is the fact that the author, being a practicing vascular surgeon,
presents an eclectic approach, which a radiologist would be unable
to do. Some examples: how to choose the best approach (percutaneous
or open) to a certain lesion; when to give up an attempt at angioplasty
and prepare the patient for an open surgical procedure; or when
to combine open and percutaneous surgical techniques in the same
case.
The quality of the book is outstanding, with many illustrations
which make learning the techniques easier. The book has only thumbnail
illustrations, which are evidently "digital thumbnail"
illustrations, made with the aid of graphic computing. Much to the
relief of this reviewer, there is not a single radiograph in this
book. In a manual on surgical techniques, radiographs are usually
used by the author to show off his technical virtuosity by carefully
choosing the cases, rather than teaching the reader the necessary
technical details of the procedure. Simple and clear illustrations,
such as those found in this book, are much more useful for the apprentice
of endovascular surgery than the most "shocking" radiographs.
The text is concise and includes only technical information. The
author's informal and good-humored style makes it easy to understand
the text, even for the reader who is not much familiar with the
English language. There is practically no reference to historical
aspects or clinical indications for the procedures described. This
may be the only negative aspect of the book: the absence of a historical
or clinical context for endovascular procedures. However, such an
absence does not lessen the value of the book, which only objective
is expressed in its title: to teach technical "skills"
to its readers.
In summary, the book Endovascular Skills is a small jewel
for young surgeons on training, as well as for surgeons experienced
in traditional surgical techniques, but who are only now stepping
into this brave new world of endovascular surgery.
Ricardo
C. Rocha Moreira
1.
Schneider PA. Endovascular Skills: Guidewires, Catheters,
Arteriography, Balloon Angioplasty, Stents. St. Louis (MI):
Quality Medical Publishing, Inc.; 1997. 223p.
