Yeah, the orientation of this cooler was limited by the orientation of the Socket AM2 bracket. Most all the newer boards I've seen use this vertical orientation, so you're pretty much stuck if you aren't using an LGA 775 processor. The new ZEROTherm Nirvana, on the other hand, features a clip that can be rotated 90 degrees, allowing the optimal front-to-back airflow.
Thermally, this cooler didn't really 'wow' me. Even on a high-power Athlon 64 X2 6000+ overclocked to 3.2 GHz (125W TDP), the fan on this cooler had to work hard to keep things under 70 C when loading both cores with F@H, ramping up to about 2200 RPM on the motherboard's smart fan controller. Now, to be fair, what the Vanquisher really has going for it is relatively compact size for a tower CPU cooler, but it seems to be the most 'budget'-oriented of the three offerings from OCZ. The heatsink base was also rough - it could have used a good lapping.