Objective:  Dialysis-associated steal syndrome (DASS) is a complication that may occur in >4% of patients with arteriovenous fistula. The best treatment method for this condition is up till now controversial. Aim of the work:  The purpose of this study was to evaluate two common procedures to treat this condition; Distal Revascularization  with Interval Ligation (DRIL) or Revision Using Distal Inflow (RUDI) aiming at preservation of both the function of the fistula and the limb. Patients and methods:  Fourteen patients having native brachiocephalic  or brachiobasilic hemodialysis  AV  fistula  complicated  by  dialysis  associated  steal  syndrome  (DASS),  were randomly divided according to treatment method into DRIL and RUDI groups with 7 patients in each group. Patients with proximal or distal arterial disease and those with low-flow steal were excluded  Short term access patency and limb salvage were set as primary endpoints. In all patients great saphenous vein was harvested  from the thigh. Early post-procedural  follow up and mid-term  follow up were after one and three months. Results:  From November 2011 to March 2013, 14 patients presented with (DASS). In DRIL group  (7 patients),  the mean age  was 49.2 years,  4  females and 4 diabetics  while in RUDI group (7 patients), the mean age was 52.3 years, 5 females and 7 diabetics. All fistulas were brachiocephalic  and  only one  was brachiobasilic  AVF in DRIL group.  All patients in both groups presented with pain, pallor, coldness and cyanosis of the hand  Stage III DASS {rest pain) was present in 2 cases of each group, whereas Stage IV small superficial ulcers were present in 3 vs 4 and digital gangrene in 2 vs. 1 in DRIL vs. RUDI respectively   In group 1 (DRIL) technique; 5 patients (71.4%)  had marked improvement of pain, cyanosis, capillary refill and coldness. Pallor improved in all cases. Distal pulses returned in 4 patients, remained  weak in one patient and failed to return in 2 (28.6%). Closure of the access was necessary in 2 patients due to infection in one and due to risk of limb loss in the other; access patency was (71.4%) and limb salvage was (100%). In RUDI cases, pain, hand coldness, pallor and cyanosis greatly improved in all cases post-operatively. Distal pulses and capillary refill returned and became comparable to the healthy  side in 6 patients  (85 7%). Limb salvage and access patency  were achieved in all cases (100%). Conclusion:  RUDI  procedure incorporates  most  of the advantages  of other  access  and hand-preserving procedures. In contrast to DRIL procedure, it is the fistula that is placed at risk by ligation and revascularization,  not the native arterial supply to the ischemic  hand  RUDI may become the procedure of choice  for patients with dialysis-associated  steal syndrome after a brachial artery-based arteriovenous fistula.