The Effect of Buttonhole Cannulation vs. Rope- ladder Technique on Hemodialysis Access Patency

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 12months (inter-quartile range: 4-27months). 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.