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The surgical management of aortic aneurysms (AA) has undergone a dramatic change in the last decade. Endovascular grafts introduced by a small arteriotomy or percutaneously are increasingly replacing open surgical operations. This minimally invasive procedure of endovascular grafting of aortic aneurysms can be considered a true revolution in the field of vascular surgery.
This textbook on conventional surgical and endovascular management of aortic aneurysms, the first in the new millennium, has been published as a companion to the European Vascular Course conducted by the European Society for Vascular Surgery. The contributors to this fairly comprehensive book are renowned vascular and endovascular specialists mainly from Europe; there are some from North America too. The production quality is excellent.
The book consists of 32 chapters covering the subject on almost all the aspects from epidemiology and natural history of aortic aneurysms to the surgical risks and quality of life after elective aneurysm repair. The hulk of the chapters (18) and the initial thrust, not surprisingly, have been on endovascular management of aneurysms. This new technology threatens to overtake conventional management of AA, though presently only about 20–50% aneurysms qualify for such treatment. Laparoscopic aortic surgery and video assisted aortic surgery has also been included in the volume to give a comprehensive overview of the subject.
The authors and editors arc to be commended for bringing out an excellent book for all personnel involved in the management of AA, especially those involved in its endovascular treatment. (vascular surgeons, interventional radiologists and cardiologists). However, despite some excellent chapters like the one on Preoperative imaging techniques by Jan Blankensteijn, the book gives an impression of being hurriedly compiled. The sequencing of chapters could have been better (eg. Chapter 23 on risk, assessment could have come earlier as the risk assessment is similar in both procedures (open repair or endovascular), and He latter procedure occasionally requires conversion to open repair. Technical aspects of placement of AAA devices, as well as intraprocedure difficulties and their solution (troubleshooting) have not been addressed at all. A volume of this nature could have done with some more diagrams/photographs. Conceptual issues like whether routine suprarenal fixation of AAA (as in Talent and Zenith endografts) is better than the infra renal fixation have not been discussed. “Hybrid procedures” (combined endovascular and open approach) do not find a mention, nor do the percutaneous devices (eg. Perclose) for AAA device insertion. The important issue that several aortic endografts have been withdrawn from the market after fairly extensive use (was the insertion of these “suboptimal” devices ethical in the first place?) has also been ignored.
If this critique appears harsh, I can only state that better was expected from an international publication of this stature from Europe. Perhaps it is difficult to do justice to this rapidly evolving and expanding field of endovascular management of AA. The authors have largely, but not completely succeeded in their stated aim of providing, “comprehensive textbook, concentrating on crucial subjects related to the treatment of aortic aneurysms”.
Notwithstanding its shortcoming the book is strongly recommended for practising vascular surgeons and other specialists actively involved in the conventional (surgical) or endovascular management of aortic aneurysms. It will also be a useful addition as a reference manual to the libraries of Medical Colleges and large hospitals.