domingo, 15 de agosto de 2010

Handbook of Venous Disorders.

Handbook of Venous Disorders. Guidelines of the American Venous Forum By Peter Gloviczki
Publisher: Oxford University Press 2009 624 Pages ISBN: 0340938803 PDF 64 MB

"Venous disease is among the most common medical conditions to affect mankind -- approximately 1-3% of the population of the Western world is estimated to have severe venous problems at some point in their lives." So begins the first chapter in the second edition of the Handbook of Venous Disorders edited by Gloviczki and Yao. Should there be a definitive textbook on the pathophysiology and treatment of venous disease? Considering the magnitude of this problem, the answer is a resounding yes. The Handbook of Venous Disorders clearly fills this role. This thoughtful and well-constructed book is divided into seven sections. The first, entitled "Basic Considerations," includes a review of the anatomy and physiology of veins and the natural history of venous disease. A great deal of practical information is available in these chapters. For example, there is a section on the role of oral contraceptives and hormonal therapy in the development of deep venous thrombosis. I particularly recommend the chapter by Meissner and Strandness on the epidemiology and natural history of acute deep venous thrombosis, which details the recommended duration of treatment of deep venous thrombosis and the anticipated rate of resolution of thrombus. Subsequent summaries of the history of venous disease, venous pathology, and cellular physiology are well written and informative but of less general interest. The evaluation of patients and the diagnosis of venous disease are explored in the next section. A chapter on clinical assessment is thorough and well written. The use of physical examination rather than the reliance on noninvasive imaging for the diagnosis of venous disorders is stressed. Subsequent chapters, however, do outline the role of duplex ultrasonography in the diagnosis of acute and chronic venous disease. The important matters of the indications for ultrasonography and the limitations of noninvasive imaging are addressed. There is also a detailed description of ultrasonographic techniques. The core of the book is found in the sections on the management of acute and chronic venous disease. The coverage is comprehensive; every possible treatment of venous disease is described. Either the creator of a particular technique or an expert in the particular field has written each of these chapters. The treatments reviewed range from anticoagulant therapy for deep venous thrombosis to endovascular reconstruction of the superior vena cava. The discussion of low-molecular-weight heparin is excellent and will be useful for practitioners who are undecided about whether to treat deep venous thrombosis on an inpatient or outpatient basis. Invasive treatments for venous disease are also well described. The chapter on subfascial, endoscopic perforating-vein surgery for patients with chronic venous insufficiency is necessary reading for surgeons who wish to gain expertise in techniques designed to treat venous ulceration. The remaining sections review less common conditions affecting the veins: trauma, venous malformations, and tumors. Lymphedema, a frequent cause of leg edema and often included in the differential diagnosis of venous disease, is also discussed. In recent years, a system for the classification of venous disease has been developed, and in a final section entitled "Issues in Venous Disease," this system is described clearly. Issues regarding the reporting of outcomes in patients with venous disease are addressed as well. In sum, this is a comprehensive book that provides information about every aspect of venous disease. A tremendous amount of practical information is included, and many of the chapters are quite detailed. For this reason, the book may be of limited value to the practitioner who is seeking a quick answer to a question regarding a specific patient. However, a physician whose practice includes many patients with venous disease would gain tremendously from reading selective chapters. Handbook of Venous Disorders is an essential reference for vascular surgeons and specialists in vascular medicine. The strength of this textbook is its completeness and the fact that the chapters are uniformly clear and well written. I congratulate the authors on a job well done.

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