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©2013 UpToDate ® Print Email Bypass revision for brachiocephalic fistula steal Surgical options for bypass revision for brachiocephalic fistula steal are illustrated in the figure. (A) Distal revascularization-interval ligation (DRIL): The brachial artery just distal to the anastomosis is ligated, and a bypass is created from the more proximal brachial artery to the proximal radial artery. The distal circulation is dependant upon the new bypass. (B) Revision Using Distal Inflow (RUDI): The origin of the fistula is ligated on the venous side followed by a revsion from a more distal arterial source to the venous limb. In contrast to the DRIL procedure, the RUDI procedure maintains the native arterial circulation.