The establishment and maintenance of a functioning arteriovenous access site is essential for the care of the hemodialysis (HD) patient. Ischemic monomelic neuropathy (IMN) represents an underappreciated complication and an unrecognized source of short- and long-term disability because of its protean manifestations in the post-operative period. Delayed diagnosis of IMN greatly reduces the chance of avoiding irreversible disability. Prompt diagnosis and early management of IMN can avoid morbidity for the patient, diminish healthcare costs for the system and avoid medical liability for care providers. A multidisciplinary awareness of the symptoms of IMN is essential to permit prompt diagnosis and management.