Introduction: Dialysis-associated steal syndrome (DASS) is a rare with incidence range (1.6% to 8.0%) but important complication with significant impact on limb functionality and viability. Flow-limiting surgical procedures such as anastomotic plication or narrowing of the efferent vein with banding are easy ways of treating DASS. Aim: Aim of this study was to evaluate the technique of controlled blood flow reduction (plication of the anastomosis) in brachial fistulas against DRILL in management of DASS regarding the success of hand revascularization with fistula preservation, duration and complications of the techniques. Patients and methods: This study included 21 patients presented to the vascular surgery department at Cairo University teaching hospitals having dialysis shunt associated steal syndrome with autogenous brachial artery based accesses, between May 2015 and October 2016. Results: The patients were into two groups; group (1) included nine patients treated with DRILL procedure while group (2); for twelve patients treated with plication of fistula’s anastomosis. In case of fistula plication, the blood flow was put down by approximately 50% of the initially measured flow. Time of follow-up was 18 months. Regarding group 1 six patients still undergo hemodialysis via the fistula with normal hand function. Regarding group 2 nine patients still undergo hemodialysis via plicated fistula with normal hand function. Conclusion: We evaluated the plication technique in treatment of DASS that we have established in our institution. We found that fistula plication under blood flow control as easily performable procedure is an adequate therapeutic option in patients with DASS. Keywords: DASS, DRILL, fistula plication.