revision using distal inflow revision using distal inflow revision using distal inflow (rudi) is a surgical treatment for dialysis-associated steal syndrome. rudi was first proposed by david j. minion and colleagues in 2005. in the procedure, the fistula is ligated at a location slightly proximal to the anastomosis. a bypass to the venous outflow is then created from a distal arterial source. in a review of a three studies on the efficacy of the technique, rudi was shown to provide good patency (80%-100%) and 100% symptom resolution.