Vascular brachytherapy, 2nd ed

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Vascular brachytherapy, 2nd ed

Ron Waksman; Armonk; 1999; Futura; 630 pages;$149.00.

Use of radiotherapy to change the outcome of healing after endovascular arterial intervention has not received much attention in the vascular surgery literature. This text reviews this topic in depth and actually may be too comprehensive for the average vascular surgeon interested in learning about this topic. The book is written primarily from a cardiology perspective, in that the editor and a significant number of the contributors are cardiologists with experience in the treatment of coronary atherosclerosis with angioplasty, stent placement, or pharmacology to manipulate the response to arterial injury. It is difficult to evaluate the background of the authors because many of the contributors are listed without a title or degree and only a hospital affiliation. The text is divided into sections, and each chapter is relatively short. Most chapters conform to a standard format, with an introduction, text, and summary, and are generally well referenced. Unfortunately, the information is often redundant, a problem easily correctable with better editing. For example, the six chapters at the beginning of the text on mechanisms of restenosis could be combined into one comprehensive chapter. A review of scientific trials that have studied the effects of brachytherapy on restenosis was thorough and valuable, and the separation of data from animal and human studies was quite useful. Because most of the research in this area has been directed at restenosis in the coronary arteries, it is not surprising that the same problem in peripheral vessels is only addressed in one section. The chapters on radiation biology and vascular pathology provide a comprehensive review of radiation injury to blood vessels. The sections on radiation physics, systems for endovascular brachytherapy, and finally regulatory and health care milieu issues are important for completeness but offer little interest, except for those who plan to practice brachytherapy. Full-color photomicrographs are used intermittently in the text and serve to effectively enhance the pathologic findings. In summary, this comprehensive text, which covers the treatment of restenosis with brachytherapy, is well conceived. Because the field is relatively new and follow-up of clinical outcomes relatively short, I would suspect that a new edition is already planned. Better organization and editing will help to make future editions more valuable.

Kenneth Mclntyre, MD University of Texas Southwestern Surgical Associates Dallas, Tex