Do you recommend buttonhole cannulation for arteriovenous fistulas?  

No, I do not recommend routine buttonhole cannulation of arteriovenous fistulas. RCTs have shown a high risk of infections with S aureus bacteremia with buttonhole cannulation and no difference in AV fistula survival, surgical and endovascular interventions or patient comfort when compared to rope l...

Prefer rope-ladder cannulation first. I do recommend buttonhole cannulation if the fistula is deep/short in length, as long as proper sterilization and cannulation techniques are followed. This, along with keeping the access flow low, preserves the fistula for a long time, in my opinion.