Saad EA. Portal Hypertension: Imaging, Diagnosis and Endovascular Management, 3rd Ed. Theime; 2017; 344 pp; 242 ill; $149.99
Portal hypertension is an end-stage manifestation of liver cirrhosis with numerous, potentially life threatening and life-altering manifestations. Radiology, and specifically interventional radiology, play a central role in its diagnosis and management. Procedures range from as simple and mundane as paracentesis to as complex and exotic as a percutaneous mesocaval shunt. This book, Portal Hypertension: Imaging, Diagnosis and Endovascular Management. 3rd Edition, provides a 360-degree exploration of portal hypertension geared towards the interventional radiologist.
This book is divided into four sections and the first is on the pathology/pathophysiology of cirrhosis and portal hypertension. The second section provides an overview of medical, endoscopic and surgical management of portal hypertension. Section 3, the meat of the book, contains 17 of the 33 chapters. It has detailed chapters on all aspects of Transjugular Intrahepatic Portal-Systemic Shunt (TIPS) including patient selection, physiologic effects of TIPS, and expected clinical results of TIPS. The final section is on the balloon-occluded retrograde transvenous obliteration of varices and its variations.
This book is detailed, comprehensive, well illustrated (>250 figures), and well organized. The authorship is a veritable “Who’s Who” of interventional radiologists with many “household names” in IR including past presidents of the Society of Interventional Radiology (SIR) and Gold Medalists in SIR. The most illustrious author, underscoring the high quality of authorship within this book is the late Dr. Josef Rösch. Amongst Dr. Rösch’s many contributions to the field of medicine and interventional radiology, was a discovery he made in 1969, when he accidentally punctured the portal vein while performing a transjugular cholangiogram. While others without his brilliance and creativity would have seen accidental entry into the portal vein as simply a mistake, he realized that this would allow the possibility of creation of a shunt for the treatment of portal hypertension. Hardly a fluky discovery, the story of this discovery exemplifies the saying, “Luck is what happens when preparation meets opportunity.” TIPS is now centrally important in the treatment of portal hypertension. Dr. Rösch’s importance in the field of IR only continued to blossom from then on. It is therefore fitting that, nearly 50-years later and shortly before his death, he authored the chapter entitled, “Technique for the Transjugular Intrahepatic Portosystemic Shunt Procedure.”
One downside of this book, with multiple authors and multiple chapters, is overlap of information, especially in the introductions of each chapter. Some authors have tried to make their chapters be “stand alone” reading. For example, chapter 20 deals with Doppler surveillance of TIPS (diagnosing TIPS stenosis by ultrasound). The first two pages of this 8-page chapter discuss the pathogenesis of cirrhosis and portal hypertension, indications, and contraindications of TIPS. Each of these topics have dedicated and detailed chapters in the book. This redundancy slows the reader from reading the book cover-to-cover, but could be advantageous if someone wanted to read only selected chapters, when needed.
I highly recommend this book to all interventional radiology trainees and any practicing interventionalist who wishes to learn more about portal hypertension. A diagnostic radiologist with an interest in liver imaging or who attends multidisciplinary liver-focused conferences (liver transplant conference) may also find the information useful. This book is the first in a series of collaboration between Thieme publishing and the SIR. It is this reviewer’s hope that other books in this series remain as comprehensive, well written, and well illustrated as this; they will have a lot to live up to.
