title: The effect of buttonhole cannulation vs. rope-ladder technique on hemodialysis access patency.
abstract: The rope-ladder (RL) technique is the most common technique used for cannulation of arteriovenous fistulae (AVF). Buttonhole cannulation (BHC), or constant-site technique, is recommended by the National Kidney Foundation's Kidney Disease Outcome Quality Initiative (NKF/KDOQI) vascular access guidelines. We compared outcomes of primary patency, episodes of bacteremia, access blood flow (Qa), and quality of life (QoL) scores between RL and BHC patients. Using a prospectively collected, vascular access database, a total of 45 prevalent dialysis patients using BHC were compared with 38 patients using the RL technique over a median of 12 months (inter-quartile range: 4-27 months). The two groups did not differ significantly in demographics except that diabetes was more common in those using BHC as compared to rope-ladder (69% vs. 34%; p = 0.002). Risk factors associated with lack of primary patency were age (hazards ratio [HR] = 1.02 per decade; 95% CI: 1.00-1.03; p = 0.04) and female gender (HR = 1.92; 95% CI: 1.08-3.40; p = 0.03). Use of the buttonhole technique was not associated with improved primary patency (HR = 1.22, 95% CI: 0.65-2.28; p = 0.53). Episodes of bacteremia and mean scores from KDQOL-36 did not differ significantly between the groups. This study demonstrates for the first time that BHC use is not associated with improved access patency.
authors.affiliation: Division of Nephrology, Department of Medicine, Madison, Wisconsin.
authors.forename: Micah R
authors.initials: MR
authors.lastname: Chan
authors.forename: Olatokunbo
authors.initials: O
authors.lastname: Shobande
authors.forename: Hemender
authors.initials: H
authors.lastname: Vats
authors.forename: Maureen
authors.initials: M
authors.lastname: Wakeen
authors.forename: Xinliu
authors.initials: X
authors.lastname: Meyer
authors.forename: Janet
authors.initials: J
authors.lastname: Bellingham
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Yevzlin
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies