• LE-PDVA is one of the alternatives for dialysis access-challenged patients.

  • Buttonhole technique (BHT) can also be considered and used successfully for LE-PDVA.

  • With strict infection prevention measures, risk of infection from BHT can be reduced.


Vascular access is an essential component for a successful hemodialysis program. Cannulation technique is an important factor for dialysis access survival. For patients with exhausted upper limb vascular access, lower extremity permanent dialysis vascular access (LE-PDVA) is one of the alternatives. The buttonhole cannulation (BHC) technique for LE-PDVA has never been reported in literature. Here we report on a 57-year-old end-stage renal failure patient who had suffered multiple complications related to dialysis access and ended up with exhausted upper limb vascular access. The BHC technique was successfully used on his LE-PDVA for hemodialysis.

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