Hello,

I am interested in finding out why the buttonhole technique is not used in PTFE grafts.

I have found suggested reasons why the material is not suitable such as the thin and weak construction of PTFE grafts.

There is also predicted complications such as one site itis as the graft can repair itself like the buttonhole track.

Has anybody tried to buttonhole a graft or do they know of any papers describing the outcome of independent studies which tried to buttonhole a graft?

thanks for reading this and I look forward to hearing back.

Once a hole is punctured in a synthetic graft, it remains there, it does not repair itself. Therefore, every time the graft is stuck in that same spot, it would eventually make the hole larger, and there would be leakage around the entrance site. Repeatedly sticking in the same "area" will make numerous holes in the graft, and will cause a pseudo-aneurism, so the sites must be rotated to extend the life of the graft.

I agree with guest on this one. Furthermore, the buttonhole technique only works on fistulas because epithelial tissue forms the tract, and this does not occur in grafts.