Buttonhole Versus Rope-Ladder Cannulation of Arteriovenous Fistulas for Hemodialysis: A Systematic Review

摘要: Background The buttonhole technique is an alternative method of cannulating the arteriovenous fistula (AVF) in hemodialysis (HD), frequently used for home HD patients. However, balance risks and benefits compared with rope-ladder uncertain. Study Design A systematic review randomized trials observational studies (case reports, case series, without a control group, non-English studies, abstracts were excluded). Setting & Population patients (both in-center conventional HD) using AVF vascular access. Selection Criteria Studies We searched MEDLINE, EMBASE, EBM Reviews, CINAHL from earliest date databases to March 2014 comparing clinical outcomes versus technique. Intervention Buttonhole cannulation Outcomes primary interest patient-reported pain rates AVF-related local systemic infections. Secondary included access survival, intervention, hospitalization, mortality, as well hematoma aneurysm formation, time hemostasis, all-cause hospitalization mortality. Results Of 1,044 identified citations, 23 selected inclusion. There was equivocal evidence respect pain: pooled yielded statistical reduction (standardized mean difference, −0.76 [95%CI, −1.38 to −0.15] standard deviations), but no difference found among controlled difference, 0.34 [95%CI, −0.76 1.43] deviations). Buttonhole, rope-ladder, appeared be associated increased risk Limitations Overall poor quality substantial heterogeneity precluded pooling most outcomes. Conclusions Evidence does not support preferential use over either facility-based or HD. This preclude being appropriate some difficult-to-access AVFs.