Revasculariza？？o distal com laquea？？o arterial (DRIL): Tratamento de elei？？o para a isquémia em síndrome de roubo sintomático associado a FAV

complications related to vascular access for hemodialysis (hd) are the main reason for hospitalization of chronic renal patients. surgical treatment of steal syndrome associated with severe and critical limb ischemia is mandatory and urgent. the only surgical technique that ensures safety in the results with regard to the resolution of ischemia and preservation of vascular access is dril. the authors present the case of a 78 year old patient with hypertensive chronic renal failure, humeral-cephalic fistula and critical ischemia of the left hand. the clinical picture, with 13 months of evolution, was refractory to medical therapy and so a dril was performed. there was immediate remission of pain and progressive improvement of ulcerations of the fingers. at the same time the access for hd was preserved and early punctured. the authors advocate the implementation of dril as first-line treatment in these patients.