Abstract:

Abstract:Objective: To investigate the methods for reconstruction of the supra-aortic branches during thoracic endovascular aortic repair (TEVER). Methods: The clinical data of 45 patients undergoing TEVER in Peking University People’s Hospital from December 2001 to March 2014 were retrospectively analyzed. Results: A total of 64 supra-aortic branches that included 6 innominate arteries, 1 right common carotid artery, 21 left common carotid arteries, and 36 subclavian arteries, were reconstructed by hybrid technique, chimney technique and branched endografts respectively. The technical success rate was 100%, and endoleak was found in 7 cases and 4 cases died within 30 days after operation. Follow-up was obtained in 39 patients for 2 to 89 months, during which time, one case died of suspicious cerebral infraction and 2 cases died of causes not related to thoracic aortic disease; one endoleak persisted and all the bypass and chimney stents were patent. Conclusion: TEVER following supra-aortic branch reconstruction by hybrid surgery, chimney technique and branched endograft is safe and feasible. Although its short-term effect is satisfactory, its long term effect requires further observation.

Abstract:Objective: To investigate whether intentional left subclavian artery (LSA) coverage during thoracic endovascular aortic repair (TEVAR) increases the incidence of short-term postoperative cerebral infarction and paraplegia and risk of long-term postoperative cerebral infarction. Methods: The clinical data of 629 patients undergoing TEVAR from January 2004 to March 2013 were retrospectively analyzed. Of the patients, LSA coverage was not performed in 399 cases, partial LSA coverage was performed in 63 cases, and complete LSA coverage without and with revascularization was performed in 159 and 8 cases, respectively. The incidences of short-term postoperative cerebral infarction and paraplegia between patients with and without LSA coverage were compared by univariate analysis, and the risk factors for long-term postoperative cerebral infarction was determined by multivariate Logistic regression analysis. Results: Among the 629 patients, no severe ischemia of the upper limb developed after surgery; postoperative cerebral ischemia occurred in 3 cases (5%) that included 2 cases (0.5%) without LSA coverage and 1 case (0.4%) with LSA coverage; postoperative paraplegia occurred in 4 cases (0.6%) that comprised 3 cases (0.8%) without LSA coverage and 1 case (0.4%) with LSA coverage, and the incidences of short-term postoperative cerebral infarction and paraplegia between patients with and without LSA coverage had no statistical difference (both P>0.05). The average period of follow-up was 31.4 (1–123) months, and the multivariate analysis demonstrated that LSA coverage did not increase the risk of long-term postoperative cerebral infarction (OR=1.03, P=0.088), but it was somewhat increased in patients with a preoperative history of cerebral ischemia and those older than 70 years of age (OR=3.41, P=0.023 ; OR=1.90, P=0.034). Conclusion: Left upper limb can well tolerate the LSA coverage, and LSA coverage may not increase the incidence of short-term postoperative cerebral infarction and paraplegia and risk of long-term postoperative cerebral infarction.

Abstract:Objective: To observe the outcome following exclusion of internal iliac artery (IIA) during operation of abdominal aortic aneurysm (AAA). Methods: The clinical data of 108 AAA patients undergoing surgical treatment in Xiangya Hospital form June 2010 to June 2014 were retrospectively analyzed. Of the patients, 44 cases were subjected to open surgery, 61 cases received endovascular aneurysm repair (EVAR) and 3 cases underwent hybrid surgery. Seven patients underwent bilateral IIA ligation and 8 patients underwent unilateral IIA ligation in those undergoing open surgery, and 3 patients underwent bilateral IIA coverage and 5 patients underwent unilateral IIA coverage in those undergoing EVAR. Results: No intraoperative death occurred, and 6 cases died within perioperative 30 d but none of them was due to the IIA treatment. Among the 10 patients undergoing open bilateral IIA ligation or endovascular bilateral IIA coverage, one case (1/10) developed symptoms of rectal ischemia that was alleviated after one-month of anticoagulation and vascular dilation therapy, and a short-period of gluteus pain occurred in two cases (2/10), which disappeared by conservative treatment; no intermittent claudication occurred. No symptoms such as rectal ischemia, gluteus pain or intermittent claudication occurred in any of the patients who underwent open unilateral IIA ligation or endovascular unilateral IIA coverage. Conclusion: During surgery for AAA, unilateral IIA ligation or coverage exerts no obvious influence on postoperative condition, whereas bilateral IIA ligation or coverage may cause the symptoms of pelvic ischemia such as rectal ischemia and gluteus pain that can be resolved by conservative treatment.

Abstract:Objective: To evaluate the long-term efficacy of surgical therapy for popliteal artery entrapment syndrome (PAES), and improve the treatment experience. Methods: The clinical and follow-up data of 6 PAES patients treated in Department of Vascular Surgery of Peking University People’s Hospital between July 2002 and March 2009 were retrospectively analyzed. Results: Of the 6 patients, 5 cases were male and one case was female, and age ranged from 16 to 56 (average 28) years; 4 cases were popliteal artery occlusion and 2 cases were popliteal artery stenosis with post-stenotic aneurysm formation; 3 cases underwent myotomy of the anatomically abnormal muscular structure and revascularization (partial resection of the aneurysmal wall and arterioplasty in one case, partial resection of the aneurysmal wall with saphenous vein patch plasty in one case, and popliteal endarterectomy in one case, respectively) through posterior S-shaped incision in the popliteal fossa; 3 cases underwent bypass surgery with the autologous great saphenous vein without popliteal fossa exploration. Follow-up was conducted for 64 to 144 (average 110.8) months, during which time, the symptoms in all 6 patients were alleviated, and no complications such as nerve injury or gangrene occurred; no recurrent intermittent claudication was found in 5 cases and their native popliteal arteries or bypasses were patent; bypass graft occlusion was found in one patient with recurrent intermittent claudication presenting in the clinic at postoperative 49 and 51 months respectively, and it was recanalized by catheter directed thrombolysis and then underwent conservative treatment. The 1- and 5 year primary patency rate was 100.0% (6/6) and 83.0% (5/6), respectively. Conclusion: Surgical treatment is effective for PAES, and also offers a long-term patency rate. In situ revascularization via a posterior approach should be considered as first choice if the situation permits.

Abstract:Objective: To investigate the approach and efficacy of transobturator bypass surgery in treatment of infected femoral artery pseudoaneurysm. Methods: The clinical data of 4 patients with infected femoral pseudoaneurysm undergoing transobturator bypass surgery from August 2004 to July 2014 were retrospectively analyzed. Results: Of the patients, 3 cases were male and one case was female, with an average age of 26.5 (22–31) years. The cause for the pseudoaneurysm in 3 cases was femoral artery injury due to addictive drug injection and in one case it was a complication in the puncture site of arterial embolization therapy of the lower extremity. Three cases underwent simple femoral artery ligation and debridement of the infected aneurysm, and then second stage transobturator iliacofemoral bypass after the occurrence of postoperative lower limb ischemia; one case underwent femoral artery ligation and debridement of the aneurysm, and synchronous transobturator external iliac-superficial femoral bypass. The average fellow-up period was 27 (8–60) months, and the ankle brachial index (ABI) of the affected limbs of the 4 patients ranged from 1.0 to 1.1 after the procedure, and no intermittent claudication or other discomforts were noted. Conclusion: Primary or staged transobturator bypass surgery for infected femoral artery pseudoaneurysm can avoid postoperative ischemia of the lower limbs.

Abstract:Objective: To assess the arterial embolic effect and biocompatibility of the self-made small copper coils in experimental rabbits. Methods: Thirty New Zealand white rabbits were equally randomized into experimental group and control group. The terminal branches of the renal artery of the rabbits were embolized using the self-made copper coils (experimental group) or spring microcoils (Cook Inc) (control group) via a 3-F microcatheter, respectively. The vessel occlusion status and pathological changes were observed at different times after the embolization, and the laboratory parameters of the experimental animals before and after embolization were compared. Results: Angiography showed that the embolic effect in experimental group was inferior to that in control group at 30 min after embolization (P<0.05), but the embolic effect had no significant difference between the two groups at each time point from 3 d to 12 weeks after embolization (all P>0.05). After embolization, the renal gross morphological changes of the two groups were similar, and the thrombosis formation showed no significant difference between the two groups (P>0.05), but the perivascular inflammatory response in experimental group was milder than that in control group (P<0.05). After embolization, the changes in parameters of liver and renal function showed no significant difference between the two groups (all P>0.05), and 2 weeks later they all returned to pre-procedure levels; the serum copper level in experimental group was increased within 2 weeks compared with preoperative level (all P<0.05), but returned to preoperative level after 4 weeks (all P>0.05). Conclusion: Self-made small copper coils have similar arterial embolic effect as spring microcoils, and, in addition, has higher biocompatibility.

Abstract:Objective: To investigate the changes in proportion and function of the CD4 T cells and regulatory cells (CD4+CD25highCD127– Treg cells) in peripheral blood of arteriosclerosis (AS) patients. Methods: AS patients (AS group) and healthy subjects undergoing health maintenance examination (healthy control group) were selected with 40 cases in each group, and then the samples of peripheral venous blood were obtained. Using flow cytometry, the proportions of CD4 T cells, CD8 T cells, IFN-γ+ CD4 T cells, TNF-α+ CD4 T cells and CD4+CD25highCD127– Treg cells were measured, and the changes in ability of proliferation and cytokine secretion of the CD4 T cells after co-culture with respective CD4+CD25highCD127– Treg cells were also determined. Results: In AS group compared with healthy control group, the proportion of CD4 T cells and CD4 T/CD8 T ratio were significantly increased and the proportions of IFN-γ+ CD4 T cells and IFN-α+ CD4 T cells were also significantly increased (all P<0.05), but the proportions of CD8 T cells and CD4+CD25highCD127– Treg cells showed no significant difference (both P>0.05). In healthy control group, the abilities of proliferation and IFN-γ and IFN-α secretion in CD4 T cells were all significantly lower in co-culture with CD4+CD25highCD127– Treg cells than those in single culture (all P<0.05), while these parameters in AS group showed no significant difference between single culture and co-culture (all P>0.05). Conclusion: There is loss of function of CD4+CD25highCD127– Treg cells in AS patients, which results in the increased proportion and cytokine secretion ability of CD4 T cells, and thereby triggers the inflammatory state in AS.

Abstract:Objective: To construct the artificial miRNA expression cassettes targeting hTERT gene and validate their inhibitory effect on telomerase activity in HepG2 cells. Methods: Three artificial miRNA expression cassettes targeting different sites of hTERT gene were designed and constructed by overlap extension PCR method. After identification, the cassettes were transfected alone or co-transfected into HepG2 cells, and then the telomerase activities in HepG2 cells were detected by TRAP-silver staining and TRAP-duplex scorpion probe fluorescence quantitative PCR. Results: The three artificial miRNA expression cassettes targeting hTERT gene were all successfully constructed, and after they were transfected alone or co-transfected into the HepG2 cells, the telomerase activities in HepG2 cells were inhibited to different degrees, and the inhibitory effect of co-transfection with two miRNA expression cassettes was significantly stronger than those of any lone transfection. All the differences reached statistical significance (all P<0.05). Conclusion: The artificial miRNA expression cassettes targeting hTERT gene can effectively inhibit telomerase activity in HepG2 cells, and combined inhibition is an effective experimental program.

Abstract:Objective: To establish the living-mice colonoscopy platform, for providing a novel approach to study intestinal tumor in mice model. Methods: The living-mice colonoscopy platform was constructed by installing an URF-V fiber ureteroscope in the endoscope system, and then, 44 ApcMin/+ mice of 6- to 14-weeks old (characterized by spontaneous development of multiple intestinal adenomas) were used to conduct colonoscopic examination under anesthesia. The size and number of the adenomas were observed, and colonoscopic tumor scoring as well as tissue biopsy of the lesions were also performed. Results: Colonoscopic examination was performed 58 times in the 44 mice, 3 mice died, no intestinal perforation was observed, and the success rate was 99.71%. No tumor formation was discovered in only one mouse, while significant tumor was observed in all the other mice, and the mean tumor number and score was 3.60±1.52 and 3.26±1.29, respectively. Biopsy pathological examination showed that the lesions were intestinal tubular adenomas. Conclusion: The living-mice colonoscopy platform established in this study can be safely and effectively applied in colonoscopic examination for mice.

Abstract:Objective: To systematically assess the association between the gene polymorphism of glutathione S-transferases T1 (GSTT1) and gastric cancer susceptibility in Chinese population. Methods: The case-control studies on relationship between GSTT1 gene polymorphism and gastric cancer susceptibility in Chinese population were collected by searching several national and international databases. Meta-analysis was performed according to the GSTT1 genotype distributions in case group and control group. Results: Seventeen case-control studies were finally selected, with a total of 2 468 gastric cancer patients in case group and a total of 4 745 healthy subjects in control group. Results of the Meta-analysis indicated that the risk of gastric cancer was increased in subjects with GSTT1 null genotype compared with those with GSTT1 present genotype, and the pooled OR in fixed-effect model and random-effects model was 0.84 (95% CI=0.76–0.93) and 0.83 (95% CI=0.71–0.96), respectively. Results of subgroup analysis according to sample size showed that the pooled OR was 0.87 (95% CI=0.77–0.98) for studies with sample size larger than 100 and was 0.77 (95% CI=0.63–0.94) for studies with sample sized equal to or less than 100, respectively. Conclusion: GSTT1 gene polymorphism is closely associated with gastric cancer susceptibility in Chinese population, and those with GSTT1 null genotype face an increased risk of gastric cancer.

Abstract:Objective: To investigate the feasibility and efficacy of endovascular therapy for patients with recurrence of Budd-Chiari syndrome (BCS) after radical surgery. Methods: The clinical data of 15 patients undergoing interventional treatment for BCS recurrence after radical operation were retrospectively analyzed. Results: In the 15 patients, the age ranged from 30 to 68 (average 46.4) years; interventional procedure was performed 18 times (3 and 2 times for one case each), which included balloon angioplasty of inferior vena cava (IVC) in 10 cases, IVC balloon angioplasty after catheter direct thrombolysis in 5 cases, balloon angioplasty of IVC, hepatic vein and accessory hepatic vein in 2 cases, and IVC balloon angioplasty and stent placement in 1 case. No perioperative complication such as pulmonary artery embolism or pericardial tamponade occurred. Fifteen patients were followed up for 12 to 106 (average 41.9) months, during which time, 13 patients showed no signs and symptoms of recurrence, one patient developed hepatic venous occlusion and then underwent hepatic vein angioplasty and stenting in another hospital, and one patient developed IVC re-occlusion and received conservative treatment. Conclusion: For patients with recurrent BCS after radical operation, timely and appropriate interventional therapy is safe and effective and may improve the cumulative patency rate and prognosis.

Abstract:Objective: To investigate the treatment method for true aneurysm of splenic artery adjacent to celiac trunk. Methods: The clinical data of 7 patients with true aneurysm of splenic artery adjacent to the celiac trunk admitted from 2000 January to 2012 June were retrospectively analyzed. Results: All patients were diagnosed by color ultrasonography, CT and angiographic examinations before operation, and underwent surgical treatment under general anesthesia. Of the patients, 4 cases underwent aneurysmectomy plus infrarenal abdominal aortosplenic artery bypass using a vascular prosthesis, 2 cases underwent aneurysmectomy plus splenectomy, and one case underwent resection of multiple small aneurysms and splenic artery ligation plus splenectomy. All patients recovered and were discharged from the hospital 10–14 d after operation. During the 2- to 14-year follow-up, 5 cases survived; 2 cases died, of which one case died of acute myocardial infarction 2 years after aortosplenic artery bypass surgery and one case died of acute cerebral hemorrhage 5 years after aneurysmal resection and splenectomy. Among the 5 survival patents, of the 3 cases that underwent aortosplenic artery bypass surgery, the anastomotic site in one case gradually became narrowed beginning from 2 years postoperatively and was completely occluded at 6 years postoperatively, but no splenic infarction, anastomotic stricture or false aneurysm was found in the other 2 cases; 2 patients received aneurysmectomy plus splenectomy. Conclusion: Aneurysmectomy combined with splenic artery reconstruction is an effective treatment method for true aneurysms of splenic artery adjacent to the celiac artery.

Abstract:Objective: To investigate the diagnosis and treatment strategies of superior mesenteric artery syndrome (SMAS), for improving the understanding and reducing misdiagnosis of this disease. Methods: Eleven SMAS patients admitted to the First Affiliated Hospital of China Medical University during June 1992 to June 2012, who had complete medical records were reviewed. Results: Of the 11 patients, 7 cases were male and 4 cases were female (male:female 1.75:1), with a high incidence from the age of 14 to 25 years (72.7%); Upper abdominal bloating and discomfort were the initial symptoms for medical attention in all cases, and were accompanied by nausea and vomiting in 6 cases (54.5%) and emaciation in 7 cases (63.6%); during the whole upper gastrointestinal radiography, apparent reverse peristalsis of the intestine was observed in 4 cases, typical "pendulum-like movement" occurred one case, and impression of the mesenteric artery over the duodenum was found in 4 cases; CT examination showed the angle between the superior mesenteric artery and the abdominal aorta was reduced (<22°) in 3 cases; 7 cases received conservative treatment such as intravenous nutrition support, and 4 cases underwent surgical treatment due to failure of conservative treatment, and all recovered after treatment. Eight patients were followed up for 6 to 12 months, and no recurrences or complications were noted. Conclusion: SMAS is relatively rare in clinical practice and easy to be misdiagnosed. Knowledge regarding this disease should be enhanced, and its diagnostic methods and treatment modalities should be standardized.

Abstract:Objective: To establish a scoring system for assessing the disease activity of thromboangiitis obliterans (TAO). Methods: One-hundred and four medical records from 88 TAO patients admitted during 2008 to 2013 were collected. The outcomes of the patients were classified as limb salvage and amputation, and the association between amputation and the clinical features and laboratory results that were potentially contributing to amputation were analyzed. The correlation coefficient of each factor with amputation was multiplied by 100 to obtain the risk score, and the cut-off value for amputation was obtained by receiver operating characteristic (ROC) curve analysis. Results: After univariate and multivariate analysis, 7 variables that included multiple digit ulcers, multiple digit gangrene, popliteal artery involvement, neutrophilic leukocytosis, anemia, hyperfibrinogenemia and thrombocytosis were finally chosen as assessing variables. The possible maximum score of the patient was 234, in which the clinical score was 86 and laboratory score was 148, respectively. The cut-off value of clinical score, laboratory score and total score was 53.5, 38.5 and 91, respectively. Conclusion: To a certain extent, this scoring system can be used for guiding the selection of effective treatment strategies for TAO patients. However, its accuracy still requires validation by further cohort studies.

Abstract:Objective: To evaluate the efficacy and safety of endovascular interventions for deep venous thrombosis (DVT) of the lower extremity with concomitant Cockett’s syndrome. Methods: The clinical data of 86 patients with lower extremity DVT and concomitant Cockett’s syndrome treated from June 2010 to June 2013 were retrospectively analyzed. The patients underwent thrombolysis by continuous micro-pump urokinase injection following the introduction of a thrombolytic catheter to the deep venous thrombus through an incision or puncture in the small saphenous vein at the lateral malleolus; at 7–10 days later, balloon dilatation alone or combined with stenting for the stenotic or occlusive segment of the iliac vein was performed, which was followed by anticoagulation, circulation-activation and compression stocking therapy, and continuous anticoagulation therapy with Warfarin or Rivaroxaban after discharge from hospital. Results: In the 86 patients, 22 cases received placement of inferior vena cava filter before thrombolysis due to acute pulmonary embolism or multiple floating thrombi in the iliofemoral vein and 5 of these 22 cases had placement of permanent filter; 35 cases underwent balloon dilatation only, and 51 cases had simultaneous stenting. After operation, the overall effective rate was 100%, no serious complications occurred, and only 4 cases presented mild bleeding complications during thrombolysis, which were resolved by adjustment of medication. Follow-up for 6 to 36 months was obtained in 82 patients, and the lumen patency rate was 91.46% (75/82), while intra-stent thrombosis or recurrence of deep vein thrombus occurred in 7 cases, which were eliminated by a repeat of catheter thrombolysis. Conclusion: Deep venous catheter thrombolysis combined with endovascular angioplasty is a safe, effective, and minimally invasive treatment for the lower extremity DVT with concomitant Cockett’s syndrome.

Abstract:Objective: To investigate the changing pattern of quality of life in patients with the lower extremity deep vein thrombosis (DVT). Methods: Seventy-four lower extremity DVT patients were selected. Using SF-36 Health Survey Scale, the scores for 8 subscales of health dimensions that included physical functioning (PF), general health (GH), physical role (RP), emotional role (RE), social functioning (SF), bodily pain (BP), vitality (VT) and mental health (MH), were determined and compared in these patients before and at 2 to 26 months after non-surgical treatment. Results: The base-line data of the patients were evenly distributed and comparable at different stages, and the overall Cronbach’s α coefficient for the scale was 0.902. Of the patients, the scores for the 8 dimensions were all significantly higher at different stages after discharge than those at admission (all P<0.05), however, all dimensions reached a plateau at 2 to 8 months respectively, where all the scores for each dimension showed no significant difference (all P>0.05). Compared with the normal values, the scores for RP and PF were slightly decreased, and score for VT was obviously decreased, but those of all the other dimensions were unchanged. Conclusion: After non-surgical treatment, the condition of DVT patients can significantly be recovered, and their quality of life may be improved for a long period of time.

Abstract:Objective: To assess the clinical efficacy of endovenous laser therapy plus transilluminated powered phlebectomy (Trivex system) in treatment of severe varicose veins of lower limbs. Methods: The clinical data of 20 patients with severe primary varicose veins of the lower extremities (26 legs) treated from July 2012 to October 2013 were retrospectively analyzed. All patients underwent endovenous laser therapy combined with transilluminated powered phlebectomy. Results: Operation was successfully completed in all patients. After operation, the lower extremity varicose veins disappeared, the complications such as pigmentation, itching, eczema and skin ulcer were attenuated in different degrees; 4 cases developed subcutaneous ecchymosis and local swelling which in all cases disappeared within one month and one cases had the lateral crus swelling, which was eliminated by puncture aspiration of fluid and elastic bandage compression; 2 cases had numbness of extremity, which disappeared after 2 months, and in 2 cases funicular callus appeared along the main trunk of the great saphenous vein and the burning sites of varicose veins, accompanied by local mild-to-moderate pain, which gradually disappeared in 2 to 3 weeks. The average postoperative follow-up was 8 months, and no recurrence of varicose veins or evident scars in the legs was noted. Conclusion: Endovenous laser therapy in combination with transilluminated powered phlebectomy is effective in treatment of severe varicose veins of lower limbs, and meanwhile it has minimal invasiveness and better cosmetic results.

Abstract:Objective: To investigate the influence of invaginated stripping of great saphenous vein on perforator reflux. Methods: Thirty-six patients (39 affected legs) with varicose vein of lower limbs associated with perforator vein reflux admitted from March 2010 to March 2012 were selected to undergo invaginated stripping of great saphenous vein. After operation, the symptomatic improvement was evaluated by using venous clinic severity scoring (VCSS) and the condition of perforator vein reflux was observed by color duplex ultrasound. Results: Follow-up was obtained in all patients at one year after operation. The score of VCSS was 1.25±1.48 before operation, which was 5.12±1.36 one year after operation, and the difference achieved statistical significance (P<0.05). A total of 143 refluxing perforator veins was detected by duplex scan before operation, with 34 in the upper leg and 109 in the lower leg, and postoperative ultrasound examination demonstrated that 28 (19.6%) previously refluxing perforator veins persisted, with 2 (5.9%) in the upper leg and 26 (23.9%) in the lower legs. Conclusion: For varicose veins with perforator reflux, superficial vein surgery alone can achieve the goal of relieving symptoms and reducing perforator reflux, while perforator vein surgery may be considered if superficial vein surgery is unsatisfactory.

Abstract:Thoracic endovascular aortic repair (TEVAR) has emerged as a promising therapeutic alternative to conventional open aortic replacement but it requires suitable proximal landing zones for stent-graft anchoring. In patients in whom the distance between the LSA and aortic lesion is too short, extension of the landing zone can be obtained by covering the LSA’s origin with the endovascular stent graft. However, this maneuver has the potential to cause immediate and delayed neurological and vascular complications. Therefore, the management of LSA is still controversial, such as whether prophylactic LSA revascularization is needed and when, and how to perform a revascularization procedure? In this paper, the authors present the current situation and progress on the above issues.

Abstract:Takayasu’s arteritis (TA) is a rare chronic vasculitis involving the aorta and its main branches, as well as the pulmonary arteries, and occurs most frequently in women in childbearing age. Currently, the diagnosis for TA active stage depends on systemic manifestations, typical ischemic symptoms, elevated acute-phase responses, and angiographic features. However, the assessment for disease activity and TA-induced damage is insufficient due to its chronic, indolent disease course and lack of specific laboratory and imaging findings. Two recently introduced multi-systemic clinical assessment tools, DEI. Tak and the ITAS 2010, seem to be helpful in assessing the disease activity and damage of TA. How to accurately determine the disease activity, timely detection of disease recurrence and properly define the timing of surgery are still unsolved problems in current clinical practice. In this article, the authors address the issues of these concerns.