I personally had several problems with clotting and infections with my Gore Tex fistula. I had it functional for less than 2 years and had several surgeries to either clear out the clots I seemed to build up or chnage the Gore Tex out, etc. I ended up with pretty bad staph (Thank God those were the days before prevelant MRSA). and had to have the GoreTex and some of my own surrounding tissue cut out.

The natural fistulas are when they take your own vein & artery and loop them together. I had less problems with those, infection wise. But I had a tendency to clot those up.

I don't understand why they wouldn't try a pheresis flow catheter in the chest first. It's a central line that is placed in the chest though some large vessels into the heart, I believe.The access lines hang out of the chest and while it is a foreign substance & still an infection risk...if her pheresis is going to be short term...it's easier to remove a pheresis flow catheter than it is a fistula (which is meant to be a permanent thing).

I totally understand the issue of you living 3,000 miles away from your sister, but if there is anyway some kind of conference call could be put in to the vascular doc or infectious disease doc or the neuro, so you could help your sister make her choice.

It's so hard to make a choice when you're up against a wall & feel that you have NO choice since your life depends on getting the treatments you need.

I'll keep checking here as I can. I'm having some issues of my own in getting my IVIG covered. I have been in your sister's shoes and will keep her in my thoughts.

Hang in there. She's lucky to have a sister who cares so much.