Recovery from ischemic monomelic neuropathy after delayed ligation of dialysis access

Ischemic monomelic neuropathy is characterized by acute painful muscle weakness shortly after access creation and neuronal axon loss without adjacent tissue necrosis, thus, differentiating ischemic monomelic neuropathy from the steal syndrome. Immediate ligation of vascular access is emphasized in current guidelines. We present two cases of recovery from ischemic monomelic neuropathy despite delayed ligation for over 20 days after ischemic monomelic neuropathy development. The gradual change in serial nerve conduction studies over the 15-month follow-up after surgical ligation was noted along with clinical recovery. Our report indicates that the clinical course and prognosis of ischemic monomelic neuropathy may be more diverse than previously known.