Abstract: Objective  To investigate the effect of multiple buttonhole puncture on intimal hyperplasia in arteriovenous fistula (AVF) and puncture point infection in hemodialysis patients.  Methods  We select 60 patients undergoing regular hemodialysis at the Blood Purification Center of Suzhou Ninth People's Hospital from January to April 2023 as the research subjects. According to the random number method, they were divided into single buttonhole puncture group (30 cases) and multiple buttonhole puncture group (30 cases). The intimal thickness, blood flow and arterial resistance index at AVF puncture area were measured before buttonhole puncture and on non-dialysis day at 3, 6 and 12 months after buttonhole puncture. Infection at the buttonhole puncture site was also observed.  Results  In the multi buttonhole puncture group after using this puncture method for 3, 6 and 12 months, the intimal thickness in AVF was lower (t=3.246, 5.585 and 6.055 respectively; P=0.002,＜0.001 and ＜0.001 respectively), natural blood flow in AVF was higher (t=2.697, 4.551 and 7.504 respectively; P=0.009,＜0.001 and ＜0.001 respectively), and arterial resistance index of AVF was lower (t=3.254, 4.779 and 5.336 respectively; P=0.001,＜0.001 and ＜0.001 respectively), as compared with those in the single buttonhole puncture group. Intimal thickness in AVF and arterial resistance index increased over time (Ftime=70.030 and 74.750, Ptime ＜0.001), while natural blood flow in AVF decreased over time (Ftime=42.610, Ptime＜0.001) in both groups. The changes of intimal thickness in AVF, natural blood flow, and arterial resistance index had an interaction effect with puncture time in both groups (Finteraction=16.740, 6.640 and 14.070 respectively; Pinteraction＜0.001). The overall incidence of infection at the puncture site was lower in the multi buttonhole puncture group than in the single buttonhole puncture group (χ2=4.812, P=0.028).  Conclusion  When using the buttonhole puncture technique for blood access from AVF, multiple buttonhole puncture can reduce intimal hyperplasia in AVF and lower the infection rate at the puncture site.

Key words: Multi buttonhole puncture method, Hemodialysis, Arteriovenous fistula, Vascular intima, Hyperplasia, Infection