Application of Buttonhole Cannulation Technique to Surgically Superficialized Arteries

In Japan, use of a surgically superficialized brachial artery is recommended for vascular access in patients who are either unable to tolerate hemodialysis because of reduced cardiac function or who do not have vessels suitable for creation of an arteriovenous fistula. Superficializing a brachial artery involves relocating a portion of the artery into subcutaneous tissue and immobilizing the artery at that location. Superficialized artery access can result in certain serious complications, such as an aneurysm and/or stenosis. In order to avoid such complications, we attempted applying the buttonhole method to this vascular access. A buttonhole track was created slightly distal from the center of the superficialized portion of a brachial artery approximately 2 weeks after superficialization. When arteriosclerosis was evident in that location, we tried to find a less sclerotic portion, under ultrasonography guidance, for creation of the arterial-side buttonhole track. For returning extracorporeal circulated blood, a normal vein on the arm with a superficialized brachial artery was cannulated with a sharp needle. Recently, however, we attempted to create a buttonhole track also on a vein for venous-side buttonhole cannulation. The brachial artery was superficialized in 5 patients. In all patients, buttonhole cannulation was successfully performed with the artery access. Buttonhole cannulation had been performed on these patients for 8-54 months. No serious complications such as a pseudoaneurysm were found in these patients. Serious complications specific to the superficialized artery access may be prevented by application of the buttonhole method.