Abstract: 【Abstract】Objective To analyze the effects of buttonhole cannulation and rope-ladder cannulation on the function of autologous arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients, and to select the best puncture method suitable for better use and protection of the AVF. Methods We searched for the literature relating to the influence of buttonhole cannulation and rope-ladder cannulation on MHD patients through PubMed, Cochrane Library, Elsevier, Wiley, CNKI, CBM, VIP, Wan Fang, and other Chinese and foreign databases by computer. Two evaluators independently screened the literature according to the inclusion and exclusion criteria. Methodological quality evaluation was conducted for the selected articles. Meta-analysis was carried out using RevMan5.3 software. Results Nine articles including 757 patients were finally selected.
Meta-analysis showed that the incidence of infection in the buttonhole cannulation group increased significantly with the increase of time. When the follow-up period lasted ≤6 months, the infection rate in the buttonhole group was 3.42 times higher than that in the rope- ladder group (RR=3.42; 95% CI 0.86, 13.69) but without statistical significance (P=0.080). When the follow-up period lasted >6 months, the infection rate in the buttonhole group increased to 14.43 times higher than that in the rope-ladder group (RR=14.43; 95% CI 3.50, 59.55), and the difference between the two groups was statistically significant (RR=8.33; 95% CI 3.17,21.88; P=0.000). The incidence of vascular stenosis or obstruction was lower in the rope-ladder group than in the buttonhole group (RR=4.64; 95% CI 2.01, 10.72; P=0.000). There were no statistical differences in the incidence
of hematoma (RR=0.70; 95% CI 0.42, 1.16; P=0.170) and thrombosis (RR=0.83; 95% CI 0.43, 1.58; P=0.570) between the two groups. Conclusion In the puncture for patients with AVF, rope-ladder cannulation method was better than buttonhole cannulation method to reduce long-term complications, and is beneficial to protect AVF and extend service life of the AVF. However, more researches are required to help develop strategies to improve buttonhole cannulation technique rather than to disable it. To better serve the patients with AVF, the advantages of buttonhole cannulation should be used as a supplement of rope-ladder cannulation.

Key words: Buttonhole cannulation, Rope- ladder cannulation, Maintenance hemodialysis, Arteriovenous fistula, Meta-analysis