REGULAR CONTENT
Final ID
427
Type
Original Scientific Research-Oral or Pos
Authors
E Barzel1, E Barzel1
Institutions
1Fresenius Vascular Care, Bala Cynwyd, PA
Purpose
Buttonholes are used to allow access into a dialysis fistula via blunt needles in order to perform dialysis. This can be safer and less painful for some patients than access with sharp needles that are typically used at dialysis. Buttonholes are often used by patients who access the fistula themselves and dialyze at home. Buttonholes may fail due to the development of false tracts or fibrosis. Tract dilatation was performed in patients whose buttonholes could no longer be easily cannulated. This study assesses the efficacy of this technique.
Materials & Methods
With ultrasound and fluoroscopic guidance, a 5Fr dilator was used to guide a Bentson wire through the failed buttonhole into the fistula. The buttonhole tract was then dilated to 7Fr or 8Fr for a minimum of 5 minutes. If the tract could not be entered, then the back end of the wire was used, or a sharp 21 gauge needle was used. Dr. Barzel performed this procedure to treat failing buttonholes beginning in January 2013 and maintained a log of outcomes through August 2015 including follow-up phone calls performed by Dr. Barzel one month after the procedure. Dr Barzel retrospectively reviewed the log to determine number of procedures performed, technical success rate, complication rate, immediate clinical success rate and clinical success rate after one month.
Results
51 buttonholes were dilated during 36 encounters in 23 patients. Both the 'arterial' and 'venous' buttonholes were treated in 15 encounters. 39 buttonholes were dilated to 7Fr, and 12 to 8Fr. Additional intervention, PTA, was performed during 10 encounters and thrombolysis performed in 2. Back end of wire or sharp needle was required in 5 buttonholes (10%). This caused buttonhole loss in one case which was the sole complication (2%). Cannulation was immediately improved in 38 buttonholes(75%). Cannulation remained improved at one month in 29 (57%) with missing follow-up in 4(8%). A total of 9 patients had two or more encounters. For patients who had more than one encounter average time between dilatations was 4.5 months.
Conclusions
Buttonhole tract dilatation is a useful method to extend the life of failing buttonholes.
Final ID
427
Type
Original Scientific Research-Oral or Pos
Authors
E Barzel1, E Barzel1
Institutions
1Fresenius Vascular Care, Bala Cynwyd, PA
Purpose
Buttonholes are used to allow access into a dialysis fistula via blunt needles in order to perform dialysis. This can be safer and less painful for some patients than access with sharp needles that are typically used at dialysis. Buttonholes are often used by patients who access the fistula themselves and dialyze at home. Buttonholes may fail due to the development of false tracts or fibrosis. Tract dilatation was performed in patients whose buttonholes could no longer be easily cannulated. This study assesses the efficacy of this technique.
Materials & Methods
With ultrasound and fluoroscopic guidance, a 5Fr dilator was used to guide a Bentson wire through the failed buttonhole into the fistula. The buttonhole tract was then dilated to 7Fr or 8Fr for a minimum of 5 minutes. If the tract could not be entered, then the back end of the wire was used, or a sharp 21 gauge needle was used. Dr. Barzel performed this procedure to treat failing buttonholes beginning in January 2013 and maintained a log of outcomes through August 2015 including follow-up phone calls performed by Dr. Barzel one month after the procedure. Dr Barzel retrospectively reviewed the log to determine number of procedures performed, technical success rate, complication rate, immediate clinical success rate and clinical success rate after one month.
Results
51 buttonholes were dilated during 36 encounters in 23 patients. Both the 'arterial' and 'venous' buttonholes were treated in 15 encounters. 39 buttonholes were dilated to 7Fr, and 12 to 8Fr. Additional intervention, PTA, was performed during 10 encounters and thrombolysis performed in 2. Back end of wire or sharp needle was required in 5 buttonholes (10%). This caused buttonhole loss in one case which was the sole complication (2%). Cannulation was immediately improved in 38 buttonholes(75%). Cannulation remained improved at one month in 29 (57%) with missing follow-up in 4(8%). A total of 9 patients had two or more encounters. For patients who had more than one encounter average time between dilatations was 4.5 months.
Conclusions
Buttonhole tract dilatation is a useful method to extend the life of failing buttonholes.