The Buttonhole Technique: How to Convert a Fistula into a Catheter

Abstract

Italian

The buttonhole technique (BT) is an alternative to the standard needling for the cannulation of arterio-venous fistula (AVF). The balance between benefits and harms associated with the BT is unclear.

In order to analyze the recent literature we searched PubMed for “randomized controlled study on buttonhole” and “review of buttonhole cannulation”, published between January 2011 and November 2013.

We identified 3 randomized trials and 3 reviews. One randomized trial showed a better survival of the AVFs (100% vs 82%), fewer interventions (19% vs 39%), and lower growth of pre-existing aneurysms (23% vs 67%) in the BT group. A second study showed a greater number of infections and hematomas, and a greater perception of pain in the BT group. A third study showed no differences in perception of pain and bleeding time between the BT group and the control group; additionally, it reported a greater number of hematomas in the control group and a greater number of local infections and sepsis in the BT group. The three reviews showed no definite results regarding the various endpoints of BT (perception of pain, aneurysm formation, bleeding time), and confirmed the increased risk of local and systemic infections.

Based on this analysis, we can conclude that the BT produces an increased risk of local and systemic infections without definite benefits. Recent studies suggest reserving the BT in selected cases (vessels particularly deep or too short stretches). However, we cannot exclude that further randomized controlled trials may lead to different conclusions on the BT.

Keywords

Vascular Access Buttonhole Cannulation of arterio-venous fistula Accessi vascolari Incannulamento della fistola artero-venosa

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References

Twardowski

Z.J.

, Kubara

. Different sites versus constant sites of needle insertion into arteriovenous fistulas for treatment by repeated dialysis. Dial Transplant 1979; 8: 978–80.

Verhallen

A.M.

, Kooistra

M.P.

, van Jaarsveld

B.C.

. Cannulating in haemodialysis: rope-ladder or buttonhole technique? Nephrol Dial Transplant 2007; 22: 2601–4.

van Loon

M.M.

, Goovaerts

, Kessels

A.G.

, van der Sande

F.M.

, Tordoir

J.H.

. Buttonhole needling of haemodialysis arteriovenous fistulae results in less complications and interventions compared to the rope-ladder technique. Nephrol Dial Transplant 2010; 25(1): 225–30.

Ball

, Treat

, Riffle

. A multi-center perspective of the buttonhole technique in the Pacific Northwest. Nephrol Nurs J 2007; 34: 234–41.

Ball

L.K.

. Improving arteriovenous fistula cannulation skills. Nephrol Nurs J 2005; 32: 611–7.

Krönung

. Plastic deformation of Cimino fistula by repeated puncture. Nephrol Dial Transplant 1984; 13: 635–8.

Vaux

, King

, Lloyd

. Effect of buttonhole cannulation with a polycarbonate PEG on in-center hemodialysis fistula outcomes: a randomized controlled trial. Am J Kidney Dis 2013; 62(1): 81–8.

Grudzinski

, Mendelssohn

, Pierratos

, Nesrallah

. A systematic review of buttonhole cannulation practices and outcomes. Semin Dial 2013; 26(4): 465–75.

Mustafa

R.A.

, Zimmerman

, Rioux

J.P.

. Vascular access for intensive maintenance hemodialysis: a systematic review for a Canadian Society of Nephrology clinical practice guideline. Am J Kidney Dis 2013; 62(1): 112–31.

10.

Chow

, Rayment

, San Miguel

, Gilbert

. A randomised controlled trial of buttonhole cannulation for the prevention of fistula access complications. J Ren Care 2011; 37(2): 85–93.

11.

MacRae

J.M.

, Ahmed

S.B.

, Atkar

, Hemmelgarn

B.R.

. A randomized trial comparing buttonhole with rope ladder needling in conventional hemodialysis patients. Clin J Am Soc Nephrol 2012; 7(10): 1632–8.

12.

Atkar

R.K.

, Macrae

J.M.

. The buttonhole technique for fistula cannulation: pros and cons. Curr Opin Nephrol Hypertens 2013; 22(6): 629–36.

13.

Roy-Chaudhury

, Kelly

B.S.

, Zhang

. Hemodialysis vascular access dysfunction: from pathophysiology to novel therapies. Blood Purif 2003; 21: 99–110.

14.

Roy-Chaudhury

, Samaha

, Zhang

. Aggressive early neointimal hyperplasia contributes to AV fistula maturation failure. J Am Soc Nephrol 2006; 17: Fpo1056.

15.

Meyerson

S.L.

, Skelly

C.L.

, Curi

M.A.

. The effects of extremely low shear stress on cellular proliferation and neointimal thickening in the failing bypass graft. J Vasc Surg 2001; 34: 90–7.

16.

Rajan

D.K.

, Bunston

, Misra

, Pinto

, Lok

C.E.

. Dysfunctional autogenous hemodialysis fistulas: outcomes after angioplasty are there clinical predictors of patency? Radiology 2004; 232(2): 508–15.

17.

Clark

T.W.

, Hirsch

, Jindal

K.J.

, Veugelers

P.J.

, LeBlanc

. Outcome and prognostic factors of restenosis after percutaneous treatment of native hemodialysis fistulas. J Vasc Interv Radiol 2002; 13(1): 51–9.

18.

Tessitore

, Mansueto

, Lipari

. Endovascular versus surgical preemptive repair of forearm arteriovenous fistula juxta-anastomotic stenosis: analysis of data collected prospectively from 1999 to 2004. Clin J Am Soc Nephrol 2006; 1: 448–54.