Successful Recovery From Ischemic Monomelic Neuropathy After Delayed Ligation and Plication of Dialysis Access: A Case Report and Review of Literature

Ischemic monomelic neuropathy (IMN) is an under-recognized complication of arteriovenous access creation among hemodialysis patients, which may lead to disability. It is marked by acute pain and sensorimotor deficits without ischemia. The true incidence of IMN remains unclear due to the paucity of reported cases. Treatment guidelines have not been established. We report a case of IMN of the right hand after the creation of a second vascular access for hemodialysis. Electrophysiologic tests confirmed the diagnosis. The patient underwent a delayed arteriovenous (AV) fistula breakdown and AV graft plication. Symptoms resolved immediately after. We also did a review of the literature. Given the potential for reversibility, early recognition is essential. Electrodiagnostic tests are valuable in the diagnosis. Surgical interventions appear to relate to better outcomes.