From The New England Journal of Medicine
In the preface to this new book, editors Peter Lanzer and Eric J. Topol state that "panvascular medicine represents a new approach, providing cohesive and comprehensive quality vascular care." They correctly point out that the care of patients with vascular disorders is currently inconsistent and fragmented. Some of the clinical specialties involved include cardiology, cardiac surgery, vascular surgery, radiology, neurology, neurosurgery, and vascular medicine (angiology). To say that panvascular medicine is a multidisciplinary field is an understatement. The challenge that faced the editors and authors of this book was not only to cover this new field, but to define it as well. The ambitious scope is reflected in the book's length of almost 2000 pages. The 133 chapters by an international group of 215 authors are organized into 10 parts containing 1800 figures and 291 tables. An extremely useful feature of the book, especially in view of its encyclopedic nature, is the detailed index that runs for 67 pages. The condensed outline with page numbers that begins each chapter is also very helpful. Part I begins with introductory chapters on vascular anatomy, physiology, and pathology, but there are also chapters on more esoteric topics such as vascular remodeling, angiogenesis, and immunobiology. Part II on vascular diagnostic evaluations includes the basic clinical examinations as well as anatomical imaging and physiological or functional testing. The vascular laboratory is well covered in separate chapters on peripheral vascular and cerebrovascular diagnostic methods. A section of three chapters is devoted to intravascular ultrasonography, which is emerging as a valuable adjunct to catheter-based vascular interventions. There are also discussions of computed tomography, magnetic resonance angiography, and conventional contrast angiography. Parts III through V cover the major areas of coronary, cerebrovascular, and peripheral arterial diseases. The section on vascular diseases of the central nervous system is particularly detailed and contains 16 chapters. The more focused topics of venous, lymphatic, thoracic vascular, and abdominal vascular diseases are discussed in parts VI through VIII. The coverage of abdominal vascular diseases is especially comprehensive (11 chapters), with sections on the abdominal aorta, gastrointestinal tract, and renal vessels. However, the discussion of venous disorders is quite brief (just four chapters) as compared with the coverage of the other major subject areas, and there is relatively little information on some important topics, such as hypercoagulable states and prophylaxis against deep venous thrombosis. The book concludes with parts IX and X on endocrine and genitourinary vascular diseases. These topics are not typically considered to be within the realm of vascular disease, and the fact that they are included illustrates how far-reaching the field of panvascular medicine may be. The editors have succeeded in defining broad boundaries for the new panvascular medicine frontier; however, their efforts to offer guidelines for integrated clinical management, as the title of the book implies, fall somewhat short of the mark. To integrate literally means to bring parts together into a whole, and although the parts are certainly well represented in this book, there is little evidence of true integration. For example, an integrated approach to a patient with pulmonary embolism might include input from specialists in pulmonary medicine, vascular surgery, anticoagulation pharmacy, radiology, and nursing. The clinical care of such a patient would take into account the coexisting conditions, the patient's socioeconomic status, and any other factors that contribute to the successful integrated management of the patient's vascular condition. As in any multidisciplinary book with multiple authors, the quality of the writing varies, and some chapters include detailed clinical recommendations whereas others provide more general guidelines. However, despite the recent emphasis on evidence-based practice throughout medicine, there are relatively few treatment recommendations offered with sufficient supporting evidence from the literature. Notwithstanding these few criticisms, this is an important and timely book. The only other book that could be considered comparable is Allen-Barker-Hines Peripheral Vascular Diseases,edited by Juergens et al. (Philadelphia: Saunders), the most recent edition of which was published in 1980. The landscape of vascular medicine and surgery is clearly changing as the borders between the various specialties become less distinct. No single physician is likely to use all the diagnostic and therapeutic approaches described in this book, but it is probable that the panvascular specialist of the near future will combine various components of expertise that are now identified with cardiology, vascular surgery, vascular medicine, and interventional radiology. In the preface, the editors conclude, "If this textbook manages to serve as a point of departure toward an integrated, interdisciplinary panvascular culture, it will have served its mission admirably." I suspect that on this measure, the chances of success are high. R. Eugene Zierler, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
"We have coined the term panvascular medicine in order to reflect the way the field is developing. Panvascular medicine is a new interdisciplinary and integrated approach to patients with vascular diseases." Eric J. Topol, Peter Lanzer
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