Peripheral Arterial Disease (ISBN:978-1-930513-96-9), a 150-page hardcover book published by the American College of Physicians, first edition 2008, and edited by 2 leading experts in the field, Emile R. Mohler III, MD and Michael R. Jaff, DO, is the latest addition to the ACP’s Key Diseases series. Mohler is the Director of Vascular Medicine at the University of Pennsylvania Health System and Associate Professor of Medicine at the University of Pennsylvania School of Medicine. Jaff is the Director of Vascular Medicine at Massachusetts General Hospital and Assistant Professor of Medicine at Harvard Medical School. Both editors are internationally recognized leaders in the field of peripheral arterial disease (PAD) and vascular medicine, providing readers of this book with an authoritative and clear resource on how to recognize, diagnose, and treat PAD.

Along with 11 other contributing expert authors, this book is a valuable reference to practicing physicians who deal with PAD, including primary care physicians, endovascular specialists and podiatrists. Utilizing evidence-based medicine, this book concisely summarizes the under-recognized prevalence and incidence of PAD; its diagnosis and differential diagnosis in an office-based setting; noninvasive modalities available to the practicing physician; medical, percutaneous, and surgical options of therapies with current indications, advantages, and disadvantages; and potential future treatments, including angiogenesis and cell therapy.

In the first chapter, Drs. Ioanna Tzoulaki and F. Gerald Fowkes describe the epidemiology of PAD. They distinguish between prevalence and incidence and describe how measuring tools and endpoints provide a range of numbers for patients with intermittent claudication, asymptomatic disease, and critical limb ischemia. They also discuss risk factors and the natural history of the progression of the disease. The authors make a point that ankle-brachial index (ABI) measurement is an excellent tool to identify subclinical peripheral and generalized atherosclerosis in the population. They also emphasize the fact that patients with PAD are at increased risk of cardiovascular events.

In the second chapter, Thom Rooke, MD reviews the history and physical exam associated with different stages of PAD and provides an easy-to-remember differential diagnosis on diseases that mimic PAD including non-atherosclerotic arterial disease and non-arterial disease. Clues on how to distinguish between these entities are described.

In the third chapter, Olujimi Ajijola, MD and Jaff describe the role of the ABI with and without exercise, segmental limb pressures, pulse-volume recordings, and duplex ultrasound in diagnosing PAD. The authors make the point that duplex imaging is reasonable in patients considered for revascularization that has lifestyle-limiting claudication and limb ischemia. Transcutaneous oximetry to assess the microcirculatory perfusion of the skin and its correlation with wound healing is also discussed.

In the fourth chapter, C. Goldman, MD and Y-W Chi, MD discuss imaging modalities in the diagnosis of PAD, including magnetic resonance arteriography, computed tomography angiography, and invasive angiography. The advantages and disadvantages of these techniques are discussed. The authors indicate that noninvasive imaging of the symptomatic patient can be performed initially to establish diagnosis and provide a baseline anatomic map for intervention.

In the fifth chapter, W. Tzou, MD and Mohler discuss medical treatment of claudication and limb ischemia, with an emphasis on antiplatelet therapy, aggressive preventative therapy, and pharmacology to improve claudication walking distance. Appropriate treatment strategies for foot ulcers are also discussed. This chapter nicely focuses on the importance of preventing the progression of disease and morbidities/mortality associated with PAD.

In the sixth chapter, Drs S. Arain and C. White review endovascular treatment modalities in treating symptomatic PAD. Data on the treatment of aortoiliac, femoropoliteal, and tibial disease are reviewed. The pros and cons and supporting data for various endovascular techniques are presented. A cost-effective approach to endovascular therapy is presented supported by existing published data.

In the seventh chapter, Drs O. Aalami and J. Matsumura describe the surgical treatment of symptomatic PAD. Graft patency, complications, and overall outcomes are discussed. Preoperative evaluation and management of these patients is reviewed, including preoperative cardiac evaluation and management and presurgical initiation of strong preventative measures such as smoking cessation and diabetes control.

In the last chapter, Mohler reviews future potential treatment of PAD, including angiogenesis and cell therapy. A review of endothelial progenitor cell and circulating endothelial cell is done. Pro-angiogenic cytokines, such as vascular endothelial growth factor (VEGF), fibroblast growth factor, and platelet-derived growth factor are also discussed. Finally, the use of stem cells in treating PAD is presented.

One of the strengths of this book is that each chapter starts with a number of questions that have direct relevance to daily practice. The answers are concise, evidence-based, easy-to-understand, and clearly free from commercial bias, which makes them an excellent, objective resource for the practicing physician, hospital quality assurance PAD programs, and third-party payors. In a field with rapidly emerging new technologies, it is imperative that scientific integrity be maintained and decisions remain based on existing strong evidence.

This book describes a cost-effective approach to diagnosis and treatment of a prevalent disease clearly underdiagnosed and undertreated. Each chapter is well referenced with a highlight to the contents of key references. Also, understanding data and concepts is facilitated by an adequately illustrated number of black and white figures and tables. The book is not exhausting with redundant information, but gets to the point quickly and comprehensively. For a busy practicing physician, it can be read within a few days and can serve as a valuable office reference afterwards.

The editors and authors can be congratulated on a job well done. I believe this book meets the editors’ expectations to provide “an easy-to-use resource for the practicing clinician, ultimately resulting in better care for our patients.”