Use of an implantable needle guide to access difficult or impossible to cannulate arteriovenous fistulae using the buttonhole technique.

Purpose: The aim of this work was to assess the safety and efficacy of the VWING Vascular Needle Guide to assist in cannulation of difficult or impossible to access fistulae using the buttonhole cannulation technique.

Methods: VWING devices were surgically implanted into patients with difficult to access fistulae. A nondevice site and a device site were used to access the fistula and perform dialysis over a six month period. The device site utilized the buttonhole cannulation technique. The performance of each access site was recorded.

Results: VWING devices were implanted in nine patients. A total of 387 cannulations took place over 1367 study days. The device site was successfully used 94% of the time compared to 77% for the nondevice site. Cannulation success was comparable between the device and nondevice sites. Ease of insertion, pain during insertion and complication rates were also comparable. No interventions were required at the device site to maintain access compared with four interventions for the nondevice access site.

Conclusions: The VWING performed as intended by facilitating required repeated access to the vascular system and access for hemodialysis treatment. The study has demonstrated that the VWING is a potential solution for access to difficult to cannulate fistulae.