Decision time: Buttonhole v. Fistula

[Simon Dog]

Finally getting the fistula, and will have to choose between buttonhole and laddering.

I know about all the conveniences of buttonholes, however, the vascular surgeon thinks they are not as good long term for the fistula as a buttonhole (but, this same surgeon thinks home hemo is "not a good idea", so he obviously does not know everything).

Any info regarding long term durability/problems of the two approaches would be appreciated.  I'm less interested in which one is easier to deal with, since I have the determination to put up with whichever is better in the long term.  As I told my doc, "I'm not here just to get another 2 or 3 years out of life" 

[cattlekid]

Well, did he give you a good reason other than he "thinks" that they are not as good long-term? 

I can tell you from my personal experience that I have had nothing but the same two buttonholes for the last 17 months and they have not given me a moment's trouble.  I have not had any vascular interventions and I have no alarms while doing my treatments.  Thrill and bruit are strong and I have had many nephrologists and other medical personnel marvel at the "beauty" of my fistula.  Other than the scars from the actual surgery, all you see on my arm are the two buttonholes themselves, no pseudoaneyursms, no bruising, never an infilrtration.

HOWEVER, I have to say that much of this is due to the fact that I do home hemo and no one cannulates my buttonholes but me.  Even in the hospital, I cannulate myself.  I think this might be where your doctor is coming from...if you are in the center environment, I can see where infections etc. might be worse with buttonholes.  But at home, it's the way to go, IMHO.

[bevvy5]

If you are determined to cannulate yourself or have one person who can do it for you, I can't imagine buttonholes NOT being the better option.

I'm a care partner with my husband and I do his cannulation.  He's had the same buttonholes that were established in February of 2012.  He does dialysis at home.  We had one occasion last summer where we had some problems getting the needles in, we went in to see our nurse, she helped us for two days in a row.  Other than that, he's had no issues at all.  When we travel, I go to whatever clinic he's dialyzing in and do his cannulation.  I use the touch cannulation method advocated by Steven (or Stephen) Mott and we are to the point where for the last three months, his needles slide in first time, every time.

And his arm looks fabulous, nothing like the bumps and lumps and stuff that you sometimes see on in-centre folks that scared the dickens out of him when he started using it.  Again, other than the scar and two little holes, you couldn't tell he has a fistula.

[noahvale]

*

[Desert Dancer]

I've had my buttonholes for 2.5 years and have never had a single issue with them. No infiltrations. No infections. Needles go in first time, every time.

Of course, no one touches them except me. My vascular surgeon was thrilled I went with buttonholes; says it's better for 'his' fistula, not poking a bunch of holes in it all over the place.

[dublin]

Finally getting the fistula, and will have to choose between buttonhole and laddering.

I know about all the conveniences of buttonholes, however, the vascular surgeon thinks they are not as good long term for the fistula as a buttonhole (but, this same surgeon thinks home hemo is "not a good idea", so he obviously does not know everything).

Any info regarding long term durability/problems of the two approaches would be appreciated.  I'm less interested in which one is easier to deal with, since I have the determination to put up with whichever is better in the long term.  As I told my doc, "I'm not here just to get another 2 or 3 years out of life" 

Hi edd here i am a newbe i am in the process of making the button hole the doctor says its the best in the long run as with the ladder up and down he says my  arm looks as if its being scared and to tell the truth it looks crap.

[GoingThere]

I had Buttonholes for 2 years without any problems, no bumps, no pain. I would definitely go fro buttonholes.

[Speedy1wrc]

A lot of depends involved.

My fistula was done in March of 2005 and is still working today. It was a rough start and it had to be repaired twice at first, but since then it's been fine. I have serious anuerisms and a lot of scar tissue, but it works. Everyone is quite amazed that it works as well as it does.

I just recently had buttonholes done and they are just now starting to work well. That said as of yesterday I have some abnormal soreness just below my arterial and going to have it looked at in a couple of hours. I am a bit worried something is wrong.

[lmunchkin]

I have cannulated my husband for almost 3 yrs now.  I do the ladder method.  Never done the buttonholes.  He never complains about it.  There is more scaring with the ladder method, but no problems sticking. Most of the time, the scaring comes from removing the needles & not the sticking.

I think if he could stick himself, he would probably do buttonholes, but as far as one allowing more longevity than the other, I don't know?  Ive only  been doing him 3yrs and he has a "nice rope."  Very strong & purring like a kitten!  I have had no problems using the "Ladder Method" at all.


God Bless,
lmunchkin

[Riverwhispering]

At the clinic they have had one tech create my button holes.  This last two treatments they were able to get the blunts in with no issue.  I was told that it really depends on your fistula and how your vein is.  Mine is like a snake and it is deep and not deep depending on where they look so there was only one small area where button holes would work and I'm thrilled it's working well.  Now when I travel it should not be an issue at other clinics.  I'm the only one in our 8 chair clinic with button holes.  The one guy that had them died recently but not from button holes.

[CebuShan]

My fistula was a deep one that they pulled to the surface. It kind of goes in a "C" shape. My Arterial is straight up but the Venus is slantd slightly. They started to do buttonholes when I was in-clinic but when I started training for Home Hemo, I couldn't get them. So I started my own. They work beautifully. I have infiltrated twice. Both times I was not feeling good and just missed. I was able to go above the infiltration and run anyway.

[dieterschien]

My buttonhole is 5 years old, with little problems. I do in center hemo and am unable to stick myself and lucky to have good staff around me. My issue is in the coming months I will be traveling to a location that doesn't do buttonhole and must surrender it.