Book Reviews

Development of Aneurysms Richard R. Keen, Philip B. Dobrin (eds.). Georgetown, TX: Landes Bioscience, 2000. ISBN: 1-58706000-0. This book is described in the preface as ``a compilation of papers devoted to the understanding of the formation and development of aneurysms,'' and contains contributions from many of the leading investigators in aneurysm biology. Aneurysm research has expanded widely in the past decade, yet there remains a relative paucity of investigation relative to other areas of vascular biology such as atherosclerosis or restenosis. Although there are several texts for the clinical management of aneurysms, this volume is one of the few that focuses on aneurysm development by bringing together relevant epidemiology, clinical features, and experimental ®ndings. The ®rst two chapters review the epidemiology and clinical features of familial and nonfamilial aneurysms. These chapters are well written and focused, and critically examine the value and limitations of the various types of aneurysm studies (i.e., population studies, autopsy series, screening of relatives), although Chapter 2 tends to focus on one clinical study conducted at the authors' institution. The next three chapters cover the mechanical aspects of aneurysm formation, including the synthesis and biomechanical properties of the extracellular matrix proteins. These are clearly written sections that explain complex biophysical concepts in a straightforward and well-illustrated manner; however, a summary at the conclusion of the more complex chapters (i.e., Chapter 4 on the mechanical properties of collagen and elastin) would help the reader better digest the wealth of concepts and experimental ®ndings reviewed. The most important chapter in this volume, ``Pathology and pathogenesis of degenerative aortic aneurysms'' (Chapter 6), is written by an anatomic pathologist who appears dogmatically convinced that aneurysms are simply a secondary manifestation of atherosclerosis. The chapter consequently largely consists of a rhetorical and repetitive denial of the accumulated clinical and experimental evidence (much of which is cited in other chapters) that aortic aneurysms are associated with but not caused by atherosclerosis and that destruction of essential structural matrix components by metalloproteinases leads to aneurysm formation. A counterpoint or com-

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mentary by the editors at the end of this chapter to put this extreme viewpoint in a more balanced perspective would have been refreshing. The highlight of the book is Chapter 7, ``In Vivo Animal Models of Aneurysms,'' which is written by the Drs. Keen and Dobrin (editors of the text). This chapter describes many of the important ®ndings derived from various animal models of aneurysms. Important experiments showing that inhibition of cyclo-oxygenases, metalloproteinases, and in¯ammation results in decreased aneurysm formation are found in this chapter and unfortunately are not covered in the chapters that cover aneurysm development. The remaining chapters cover a wide range of topics, including the possible role of infectious agents in causing aneurysms, the search for aneurysm susceptibility genes and potential pharmacologic treatment of aneurysms. In general, these are well written and explain some very complex hemodynamic and molecular biology principles well. Signi®cant de®ciencies in the molecular biology and genetic chapters include no mention of either the Human Genome Project or the applicability of gene array analysis to aneurysm disease. The section on ``Etiology of AAA'' ignored critical ®ndings regarding MMP-9 expression in human aneurysms and again is largely the presentation of data from one laboratory. The central weakness in the organization and philosophy of this book is that each section addresses one particular aspect of aneurysms and the integration between chapters is quite limited. Although any textbook in this rapidly evolving area will be somewhat outdated by the time of publication, the lack of balance in this particular text cannot be solely excused on that basis. The most critical areas to the reader, namely the cellular and molecular mechanisms of aneurysm development, are buried in chapters that address other issues and discounted or ignored in the appropriate sections. The unlimited editorial license given to the chapter authors results in highly variable quality and casual dismissal of theories and data not to the chapter author's liking. Many of the chapters focus either experimental ®ndings from the contributor's laboratory or a single clinical study and do not truly provide an overview of the area in question. A comment after each chapter by the very knowledgeable and experienced editors to put the individual contributor's perspective would have brought a balanced context particularly to chapters with distorted and one-sided bias on controversial areas. The lack of editorial commentary and balance in individual chapters leads this compilation to be a collection of often one-

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Book reviews 399

sided opinions regarding aneurysm biology, several of which are quite behind the times and at highly contradictory to the current scienti®c consensus regarding aneurysm development. Although experienced investigators will overcome this by complementing the information in this volume with their own literaturre review, the novice reader may come away with a very unbalance perspective on aneurysm development from this volume alone. The strengths of this volume are the wide range of research and clinical topics covered and the accessible easy-to-understand style of most chapters. Overall, this volume is generally illustrated with clear diagrams and appropriate pathological and experimental ®ndings. This is particularly helpful in chapters discussing complex biomechanics such as the tensile strength diagrams and schematics of ¯uid motion and aneurysm pressure development. Another excellent feature is the ``eurakah.com'' website that offers reprints, annual updates and schematic diagrams which can be downloaded (to PC or to PDA) or printed as needed. This text will serve as an excellent introduction for investigators embarking on aneurysm research. It can also be highly recommended as a reference for vascular biologists and vascular surgeons, especially those seeking to understand the complex biomechanical and biophysical aspects of aneurysm development. DOI: 10.1007/s10016-001-0234-1 Published online: 22 April 2002

Rajabrata Sarkar, MD, PhD

Vascular and Endovascular Surgical Techniques, 4th Edition Roger M. Greenhalgh (ed.). New York: Elsevier, 2001. ISBN: 0-70202-643-3. Pages: 560. Price: $149. Just as the ®eld of vascular surgery has rapidly evolved over a relatively brief period of time, the fourth edition of Vascular and Endovascular Surgical Techniques successfully mirrors that evolution by providing the reader with an up-to-date text on vascular and endovascular techniques. This latest edition is comprehensive in its scope, detailing many of the procedures performed by our vascular forefathers, as well as a number of endovascular procedures that are currently considered by many to be experimental. The text is quite complete as a stand-alone procedural atlas of the many traditional open operations commonly performed by vascular surgeons of decades past. Chapters on carotid endarterectomy by Jesse Thompson and aortic bifurcation grafting for occlusive arterial disease by Michael DeBakey provide the reader an historical perspective by acknowledged pioneers in the ®eld. Sections of the book dedicated to cervical and transthoracic sym-

pathectomy, as well as various techniques in lower extremity amputation allow students to review those procedures, which were among the earliest in the armamentarium of the vascular surgeon. These chapters are complimented by sections, that convey a modern-day perspective to the ®eld. Thorascopic sympathectomy is well described and an entire section is devoted to endovascular techniques for carotid occlusive disease, including chapters on a variety of available cerebral protection devices. Similarly, a large section of the text is devoted to the endovascular management of aortic aneurysmal disease. It is commendable that even procedures infrequently performed, such as venous reconstructive surgery and repair of venous valves using silicone cuffs, are highlighted. The practical nature of this book is evident by having individual chapters each dedicated to a unique endovascular device, authored by those most experienced with this complicated technology. Typically, pictures of the device are provided, along with a listing of appropriate guide wires and sheaths, identi®cation of suitable and unsuitable anatomic characteristics, tips on deployment, and a summary of current clinical outcomes. The experienced surgeon recognizes that a working knowledge of an endoluminal device alone is insuf®cient to manage many of the challenges encountered in the endovascular management of aortic aneurysmal disease. Thus, additional sections on the treatment of endoleak and endotension, problems of access, and conversions from endovascular to open repair help to complete the knowledge base required for this complex endeavor. The textbook is anatomically formatted, which allows the reader to discover multiple possible solutions to a single anatomic lesion. For instance, in examining options for lower extremity revascularization, separate chapters are devoted to surgical bypass, semi-closed super®cial femoral artery endarterectomy, remote endarterectomy using the MollRing Cutter, as well as subintimal angioplasty. The adoption of a problem-based structure is a signi®cant strength of the text. Vascular and Endovascular Surgical Techniques is not intended to be an introductory manual for open and endovascular procedures. The authors assume a working knowledge of surgical and interventional skills. While the illustrations are plentiful, they are not uniform and, as a result, the quality in some chapters is somewhat better than in others. Nevertheless, this textbook stands alone as a superior how-to manual for the modern-day surgeon± interventionalist interested in providing state-of-the art care to patients with vascular disease. DOI: 10.1007/s10016-001-0235-0 Published online: 22 April 2002

Victor J. Weiss, MD Elliot L. Chaikof, MD, PhD