Efficacy Of Buttonhole Cannulation (Bh) In Hemodialysis Patients With Arteriovenous Fistula: A Meta-Analysis

Objective: This study is to evaluate the efficacy of buttonhole cannulation (BH) in hemodialysis patients with arteriovenous fistula. Method: Systematic search on Cochrane Library, JBI Evidence-Based Practice Network, PubMed, EMbase, CBMdisc, Wanfang and CNKI database was performed to identify all randomized controlled trials or quasi-randomized controlled trials of BH in hemodialysis patients until May 2015. Three independent investigators evaluated all articles and extracted information. RevMan5.0 was used for meta-analysis of all eligible studies. Results: A total of 8 randomized controlled trials and 2 quasi-randomized controlled trials were included. Meta-analysis showed that compared with rope-ladder cannulation (RL), BH significantly reduced aneurysm formation [RR = 0.17, 95% CI (0.06, 0.48), P < 0.05], thrombus formation [RR = 0.44, 95% CI (0.22, 0.90), P < 0.05], and stricture formation [RR = 0.29, 95% CI (0.12, 0.70), P < 0.05]. However, there were no pain reduction [SMD = -1.48, 95% CI (-4.41, 1.18), P > 0.05] or intervention reductionfor fistula prevention [RR = 0.70, 95% CI (0.35, 1.36), P > 0.05]. Conclusions: Compared with RL, BH can significantly reduce the formation of aneurysm, thrombosis and stenosis, but there were no pain or intervention reduction for fistula prevention in hemodialysis patients with arteriovenous fistula. The efficacy of BH in infection and hematoma control, bleeding time reduction and fistula survival rate needs further study.