Vascular Disorders of the Upper Extremity

VASCULAR DISORDERS OF THE UPPER EXTREMITY. 3rd revised edition. Edited by Herbert I. Machleder. 515 pp. Illust. Futura Publishing Company, Inc., Armonk, NY. 1998. US$98. ISBN 0-87993-409-3

Vascular disorders of the upper extremity are much less common than those of the lower extremity. It is therefore more difficult for the vascular surgeon to gain an equivalent level of experience and expertise in the treatment of patients with upper extremity disorders. This book is a multi - authored text edited by a vascular surgeon who has extensive experience with the management of upper extremity disorders. Thankfully, he is also the author of 7 of the 18 chapters in the book. His experience is evident in what he writes, and that translates into well-written, readable chapters.

The book is quite logically divided into 4 separate parts. The first is devoted to the vascular evaluation and includes 3 chapters describing the essentials of the physical examination, noninvasive vascular assessment and angiography for upper extremity vascular problems.

The second part of the book includes 9 chapters devoted to the “cumulative trauma disorders” (thoracic outlet syndrome). I think it is appropriate that, although the title of the book is Vascular Disorders of the Upper Extremity, 5 of the chapters in this section are related more specifically to the essentials of diagnosis and management of neurogenic thoracic outlet syndrome, repetitive motion disorders of the upper extremity and management of neuropathic pain. For the clinician, a major problem in the management of patients having upper extremity disorders is indeed distinguishing between neurogenic and vascular problems, and a review of these chapters would be useful. The remaining chapters in this section cover the treatment of arterial and venous thoracic outlet syndrome and various diagnostic techniques, such as the electrophysiological evaluation and the use of somatosensory evoked potentials. These chapters on diagnostic techniques are quite technical and therefore difficult to read; however, they do serve as good sources of reference and illustrate the strengths and limitations of these diagnostic techniques.

The third part of the text is devoted to intrinsic and acquired disorders of the upper extremities and includes a well-written chapter on the evaluation and management of patients with Raynaud’s syndrome, a chapter on the management of patients with axillosubclavian and brachial artery disorders, and a chapter on the very complex topic of hemangiomas and arteriovenous malformations of the upper extremity. I found these chapters well organized, well referenced and containing ample illustrations and sample arteriograms of these complex lesions. There is a useful chapter discussing the complications of vascular access procedures in the upper extremity, which would provide a useful review for any practising surgeon who performs these procedures.

The last section involves a detailed discussion of upper extremity manifestations of systemic vascular disorders, namely vasculitis. This chapter is exhaustively referenced and contains well-constructed tables and classification systems. Although to most practising physicians the topic of vasculitis tends to be quite confusing, this chapter serves as an excellent reference source.

In summary, I believe this book would be of interest to the vascular surgeon, general surgeon and trainee in surgery. It serves as a useful review of various issues on the management of these often complex vascular problems. It would be a good book to have on hand for most practising physicians who encounter patients with upper extremity vascular disorders.