Ischemic monomelic neuropathy following arteriovenous access creation: A systematic review

Abstract

Ischemic monomelic neuropathy (IMN) is a rare neurological complication following the creation of hemodialysis access and is believed to result from ischemic injury to distal nerve fibers due to shunting of limb blood flow, leading to acute pain, sensory loss, and weakness with potential functional limb loss. Symptoms are typically abrupt but may appear weeks to months after surgery. We conducted a systematic review in accordance with PRISMA 2020, searching MEDLINE (PubMed), EMBASE, CINAHL, Web of Science, and Google Scholar from inception to August 2025 for reports of IMN following arteriovenous access creation, including case reports, case series, and letters with extractable clinical data, with individual patient data extracted when available. Of 184 records identified, 36 studies met inclusion criteria, describing 60 patients, most of whom developed IMN in the upper limb after brachial artery–based access. Diabetes mellitus was present in approximately 72% of cases, and clinical presentation most commonly occurred within hours to days of access creation with severe pain, sensory disturbances, and motor deficits. Early intervention, particularly prompt ligation of the arteriovenous access, was most consistently associated with neurological improvement. IMN remains an uncommon but serious complication following arteriovenous access creation, and available evidence is limited to case-based literature, precluding definitive management recommendations; however, early recognition and expeditious access ligation appear to provide the best chance for neurological recovery.