ischemic monomelic neuropathy ischemic monomelic neuropathy ischemic monomelic neuropathy is a rare, immediate, limb-threatening complication of hemodialysis access surgery. symptoms are acute hand pain and forearm muscle weakness. the major risk factors are the presence of diabetes mellitus, and the creation of a brachial artery-to-cephalic vein fistula as the vascular access. the treatment is prompt sacrifice of the access by surgical ligation.