Out of 377 patients of end-stage renal disease (ESRD) undergoing hemodialysis through a surgically constructed arteriovenous fistula (AVF), eight patients developed vascular access steal syndrome (VASS) with severe ischemia of the hand on the affected side. Six of these patients were treated with revision using distal inflow (RUDI) technique, in which the fistula is ligated, and an autologous saphenous vein graft is interposed between the disconnected vein and a distal artery. In all these

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... nts, symptoms and signs of hand ischemia regressed whereas flow through the AVF was preserved. We consider RUDI an effective procedure to address VASS because of AVF.