Eur J Vasc Surg 4, 207-208 (1990)

Book Reviews

Iatrogenic Vascular Injuries. S. E. Bergentz and D. Bergqvist, 1989, 195 pages, Springer Verlag, Berlin. $ 79.

This is the first monograph on iatrogenic vascular injur- ies, which have increased significantly during recent years, due to an increasing use of invasive diagnostic methods and catheter based treatment of arterial dis- eases. Iatrogenic vascular injuries also have an increas- ing medico-legal importance. Knowledge about the diagnosis, prophylactic measures and management of iatrogenic vascular injuries has become an indispensable part of surgical practice.

The authors founded an excellent centre for vascular surgery at Malm6 General Hospital, University of Lund, Sweden. One has long experience as an expert for the Swedish Board of Health and Welfare, and as an expert for the Swedish Board of Health and Welfare, and as an expert adviser he has extensive experience in the evalu- ation of iatrogenic injuries.

The book describes catheterisation techniques for the arterial and venous system and reviews injuries that may follow balloon angioplasty or other endovascular procedures. There is a thorough discussion of vascular injuries caused by irradiation and vascular complications of orthopaedic, neurosurgical, gynaecological, urological and head and neck operations. Finally there are chapters on injuries following general surgical operations and vas- cular injuries in children.

The chapters are systematically divided into causes of injury, incidence, prophylactic measures and treat- ment, with a superb list of references as befits a reference book.

I found very little to quibble with. The advice to use oscillography is out-of-date, and coverage of vascular injuries following operations for varicose veins is ra ther brief.

The book contains instructive black and white draw- ings and a lot of interesting arteriograms. It is recom- mended without reservation to general and vascular surgeons, for colleagues engaged in the medical treat- mdnt of vascular diseases, and not least to those respons- ible for radiological imaging of the vascular system.

The authors are congratulated on this excellent book, which is a seminal work on the important topic of vascular injuries.

Hans O. Myhre Department of Surgery,

Trondheim University Hospital, 7006 Trondheim, Norway.

Perioperative Assessment in Vascular Surgery. D. Preston Flanigan, 198 7, 384 pages, Marcel Dekker Inc, New York, ISBN 0-8247-7632-1.

"The purpose of this book is to assist the vascular surgeon in the perioperative period in making the correct dia- gnosis, selecting the correct operation (if any) assuming a technically excellent operation and recognising impend- ing or actual graft failure".

Following this statement in the preface, the book is divided into three sections, dealing with preoperative, intra-operative and postoperative assessment. The first section comprises about half of the book, the last section a mere 12%, reflecting the importance of good preoperative studies, but somewhat underestimating the value of proper follow-up in the immediate and late postoperative period.

The list of invasive, semi-invasive and non-invasive diagnostic procedures is extensive and covers most cur- rently available tests. The emphasis put on certain tech- niques differs according to the preference of different authors. In this respect it is surprising that a pedal erg- ometer is accorded a key role in the selection of patients for supra inguinal versus infra inguinal bypass, in a chapter written by the editor.

The chapter on ancillary techniques in diagnostic angiography contains a welcome and sincere paragraph on the (limited) value of intravenous digital subtraction angiography.

The black and white photograph in the chapter on intra-operative assessment of bowel viability fails to illus- trate the difference between fluorescent and nonfluores- cent intestines; nevertheless, the author concludes that

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208 Book Reviews

the qualitative fluorescein method is more accurate than Doppler ultrasound. The laser Doppler is not mentioned.

The combination of non-invasive and invasive tech- niques is welcome and provides an easily readable and fairly complete overview.

I recommend this book for general surgeons with an interest in vascular surgery, and especially for junior sur- geons in training for vascular surgery.

Hero van Urk University Hospital Rotterdam-Dijkzigt,

The Netherlands.

Lower Extremity Amputation. Wesley S. Moore and James M. Malone, 1989, W. B. Saunders. Phliadelphia, ISBN 0-7216-6485-7. £44.

This is an extremely valuable book reflecting the current amputat ion surgery practice in the United States and re- flecting the experience and interests of those surgeons, prosthetists and physiotherapists who were responsible for the development, in the United States, of the imme- diate plaster socket prostheses applied at the time of operation. Nevertheless, the book is much wider in its scope and provides a comprehensive mult i-author account of amputat ion surgery of the lower limb which is perhaps the best single guide available at the present time.

There is a review of the place of amputat ion set against the more general management of arterial isch- aemia and detailed discussion of the management of the diabetic foot and infective gangrene, the general prin- ciples of amputat ion level selection are covered and detailed assessment of selection by doppler pressure measurements, t ranscutaneous oxygen pressure measurements, skin fluorescence studies and laser doppler flow, with a section on skin temperature measurement; in all providing an excellent review of current practice. The medical problems of anaesthesia are well covered and each of the major levels of amputat ion are described in detail with the interesting exception of the Gritti Stokes amputat ion and supracondylar ampu- tation, which does not receive even a passing mention. The account of Symes amputat ion and part foot ampu- tations are outlined in considerable detail and constitute a valuable source of information for newcomers to the field. The account of the two stage Symes amputat ion is profusely illustrated and described. Below knee ampu- tation offers the three options for skin incision, circular, fish-mouth and posterior flap and, apart from the surpris- ing illustration showing a neurovascular bundle being ligated between a single pair of haemostats and thus

including the nerve, is an excellent account of this pro- cedure. The point is made on several occasions later that the nerves should be dissected from the vessels and cut under tension so that they are not included in ligatures. The postoperative management of below and above knee amputations differ widely from English and most Euro- pean practice with a preference for a rigid cast applied on the operating table with or without temporary prosthesis. For those wishing to follow the technique of preoperative fitting of the prosthesis with a plaster socket there is ample detail to enable this technique to be followed. The place of management without a rigid cast is barely men- tioned. There is no mention at all to the use of a pneu- matic early walking aid although this is available in the United States. There is a detailed account of the method for pressure bandaging the early amputat ion stump although this is not specifically recommended. The account of through-knee amputat ion is conventional al though there is a controversial hint that patellectomy is an acceptable part of the procedure. The above knee amputat ion technique details the use of myoplasty and myodesis. The technique for hip disarticulation commen- dably emphasises the use of myodesis to cover the open acetabulum and the description of hemipelvectomy in- cludes sufficient information to deal with wide variations in the degree of pathological involvement of the pelvic brim necessitating the procedure. The number of trans- lumbar amputations performed remains small but this section describes the personal experience of four cases and provides valuable detailed operative information and the prosthetic management .

The section on immediate and temporary prostheses includes extremely detailed instructions of all the prac- tical details needed for the technique and, al though out of context with the title of the book, does include the application to the upper limb. There is a useful chapter on complications including a full review literature on pain management and phantom limb sensation and there are contributions on the physiotherapy management , the amputat ion team, followed by a detailed biomechanical review with data on oxygen consumption, energy ex- penditure and the biomechanics of ambulation, all are graphically illustrated and outlined in a very clear and understandable manner. The section on prosthetics is very detailed and well illustrated and will give the practis- ing vascular surgeon a clear insight into the problems and techniques involved in prosthetic usage and

an insight into the growing methods, together with points of this science.

Kingsley P. Robinson Queen Mary's Hospital,

Roehampton, London, U.K.

Eur] Vasc Surg Vol 4, April 1990