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Despite equivalent demographic, medical, and psychosocial factors, the type D group was limited in ambulation, suggesting that type D personality is a strong predictor of disease impact in patients with IC.

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During a 5-year period, 148 patients underwent FEVAR. Upper extremity access for FEVAR was used in 98 (66.2%) patients. The median number of vessels fenestrated was 3 (interquartile range, 2-4), with a total of 457 vessels stented. Twelve were percutaneous (12.2%) and 86 (87.8%) were open. All patients that required a sheath size >7F underwent high brachial open access, with the exception of 1 patient who underwent percutaneous axillary access with a 12F sheath. The median sheath size was 12F (interquartile range, 10-12), which was advanced into the descending thoracic aorta allowing multiple wire and catheter exchanges. Results: One (1/98; 1.0%) hemorrhagic stroke in the upper extremity access group and one (1/54; 1.9%) ischemic stroke in the femoral-only access group occurred (P ¼ .67). The stroke in the upper extremity access group occurred 5 days after FEVAR and was related to uncontrolled hypertension, whereas the stroke in the femoral group occurred on postoperative day 3. Neither patient had signs or symptoms of a stroke immediately after FEVAR. The right upper extremity was accessed six times without a stroke (0/6; 0%), compared with the left being accessed 92 times with one stroke (1/92; 1.1%) (P ¼ .8). Four (4.1%) patients had complications related to upper extremity access; one (1.0%) required exploration for an expanding hematoma after manual compression for a 7F sheath, one (1.0%) required exploration for hematoma and neurologic symptoms after open access for a 12F sheath; and two (2.0%) patients with small hematomas did not require intervention. Two (2/12; 16.7%) of these complications were in the percutaneous access group, which were significantly more frequent than in the open group (2/86; 2.3%) (P ¼ .02). Conclusions: Upper extremity access appears to be a safe and feasible approach for patients undergoing FEVAR. Open exposure in the upper extremity may be safer than percutaneous access during FEVAR. Unlike chimney and snorkel grafts, upper extremity access during FEVAR is not associated with an increased risk of stroke, despite the need for multiple visceral vessel stenting.

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Objectives: Arteriovenous fistulas (AVF) are the preferred access for patients who require hemodialysis. However, some AVFs require additional surgery to augment maturation. This study determined the effectiveness of AVF revision and the clinical characteristics of patients with poorly maturing fistulas. Methods: All AVFs performed over a 5-year period (January 2006-December 2011) were reviewed, classified as radial-cephalic (RC), brachial-cephalic (BC), brachialbasilic transposition (BVT), and brachial-brachial (BB). Technical factors and co-morbidities for patients with AVFs that matured without assistance were compared with fistulas that required revision or were abandoned. Data were evaluated on a per-patient basis (c 2 and t-test, P value <.05) Results: 292 AVFs were created in 250 patients. 134/250 fistulas (53.6%) matured without assistance within an average of 71 days. Patients with AVFs that matured without revision were more likely to be male (60.6% vs 42.1%; P < .01), have a lower BMI (26.9 vs 29.8; P < .01), and a larger preoperative vein diameter (3.83 mm vs 3.42 mm; P < .02). 54 of 116 non-matured AVFs were revised (70% RC, 26% BC, 4% BVT). The more common revisions were branch ligation (52%), superficial transposition (31%), and anastomotic revision (30%). 89% required one, 9% two, and 2% required three revisions to achieve maturation. Average time from index AVF creation to maturation in revised patients was 209 days. 42/54 patients (79.2%) developing a usable fistula, increasing the overall maturation rate to 70.4%. The most common cause for abandoning a non-mature fistula was thrombosis (62%). Conclusions: Surgical revision for poorly maturing AVFs increases overall fistula maturation rates as much as 17%.