Vascular Access: Principles and Practice (Fourth Edition)

This comprehensive review of vascular access procedures is now in its fourth edition. The hemodialysis population increases by 15% annually, and advances in adjunctive cancer treatment continue to increase the demand for long-term vascular access devices. Consequently, although the procedures for establishing vascular access are independently somewhat mundane, the value of an authoritative reference on these essential procedures continues to increase. There are 40 contributing authors to this well-done compendium, which is organized into 3 sections: General Principles, Hemodialysis Arteriovenous Access, and Central Venous Access for Other Indications. The primary focus of the work is on the surgical options for long-term arteriovenous access, their results and complications. The chapter on historical development of vascular access is quite fascinating; the section on vascular access for long-term chemotherapy, nutritional support, and antibiotics, is somewhat sketchy, less comprehensive than the section on dialysis access. As with any evolving surgical technology, it is a struggle for the print media to keep up with the technological advancements. I have several suggestions for the authors in anticipation of the fifth edition. The use of ultrasound, both for preoperative planning (venous mapping), and for intraoperative placement of central venous devices, is becoming an important adjunct to this field. This valuable technology, mentioned briefly as a “bailout” strategy to be used after difficulty is encountered, deserves more emphasis. The chapter on external shunt devices (Scribner, Thomas, Buselmeier, etc.), a superseded technology which most of us have not seen for the past 15 years, can probably be omitted. Similarly, the Dialock® dialysis port system is not available, and the manufacturer has withdrawn the application for FDA approval. The illustrations, drawings of anatomic variance, and intraoperative photographs, are generally quite helpful and valuable, although I did not find the presentation of the basilic vein transposition very comprehensive. In the next edition, I would like to see a more cyclopedic display and discussion of the available devices for vascular access for chemotherapy, nutritional support, and other nondialysis indications. In the current edition, the only device illustrated in this section is a temporary dialysis catheter. The volume is liberally illustrated with good quality radiographs, intraoperative photographs, and anatomic drawings. The publication quality is excellent. This 289-page work is priced at $99, an appropriate price for a work of this quality, particularly with the density of well-reproduced illustrations. It belongs on the desk of every surgeon who wishes to optimize his patient outcomes in this often under-appreciated field.