Mueller-Huelsbeck S, Jahnke T. Complications in Vascular Interventional Therapy: Case-Based Solutions. Thieme; 2016; 280 pp; 540 ill; $159.99
Steve Harvey, the entertainer who mistakenly crowned the wrong woman as Miss Universe 2015, once said, “Failure is a great teacher, and I think when you make mistakes and you recover from them and you treat them as valuable learning experiences, then you’ve got something to share.” While mistakes in medicine are never as laughable as his, this quote underscores one of the most powerful teachers in medicine: mistakes. Winston Churchill said, “All men make mistakes, but only wise men learn from their mistakes.” While local morbidity and mortality conferences allow groups to learn from one individual’s mistakes, fear of legal action or professional embarrassment engenders reticence to present and publish our own mistakes on a national or international stage. However, physicians everywhere know the value of learning from complications. For example, by popular demand, a local morbidity and mortality conference in Austria has morphed into a major international conference (International Conference on Complications in Interventional Radiology sponsored by the Cardiovascular and Interventional Radiology Society of Europe, or CIRSE).
This book presents a total of 106 cases (illustrated with 540 images). Each case provides patient history, initial/intended treatment, problems encountered, a list of possible bailouts of the complication, an explanation of which route was chosen and how it was carried out, and finally, an analysis of the complication. What makes the cases such good learning experiences is the fact that, despite many awful-looking initial complications, only one of the patients died (but likely because of his underlying condition rather than the complication). Therefore, in reading this book, one can learn of the plethora of endovascular complications that exist, and hopefully learn how to prevent their occurrence, or at the very least, promptly recognize them when they do occur. Just as importantly, one learns of creative endovascular ways to deal with these complications.
While one of the book’s editors, Stefan Mueller-Huelsbeck, is a neurointerventionalist, only a handful of the 106 cases are dedicated to neuro-IR cases. Nonetheless, many cases are pertinent to a neurointerventionalist, including a multitude of groin access/closure complications. Others are easily transferable to a neurointerventionalist, such as coil migration or loss of a balloon-expandable stent.
This book has some shortcomings. The introductory chapters, totaling 5 pages, leave much to be desired. Many complications are not just due to poor catheter and wire manipulation, as suggested here, but to a systems-based perfect storm of misaligning communication errors and erroneous assumptions (described by the so-called Swiss cheese model). These overarching principles and strategies for addressing them are not discussed. Second, many similar cases are discussed; for example, there are 5 similar Angio-Seal complications with intraluminal extrusion of the collagen plug. Repetition is good to a point, but this becomes excessive and is at the expense of discussing a host of other complications. Finally, the uninitiated reader could get the false impression that even the most wicked-looking complications can be fixed. This is not the case; many complications do result in life, limb, or brain matter loss.
I would recommend this book for any radiology resident interested in interventional radiology (IR), all IR fellows, and any neurointerventionalist with extra time on their hands, knowing there are likely no persons in this last group.
