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 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.