The creation of a vascular access for hemodialysis is a frequently performed procedure. Ischemic monomelic neuropathy (IMN) is a rare, but important complication of hemodialysis access (HA) procedures, which can lead to severe and nonreversible limb dysfunctions. Therefore, in any case of postoperative neurological malfunction, immediate neurological investigations should be undertaken. If IMN is diagnosed, improvement of distal perfusion should be established without delay. IMN is a form of hemodialysis-associated ischemic syndrome (as the so-called steal syndrome), but experiences with this complication are small. Every case of IMN should be carefully documented and if possible published, to gain more experience about this rare but important complication.

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Based on our experience, clinical long-term results are successful in certain patients with DAIIS. The aim for the near future should be a better patency rate to minimize the need for reoperations. In cases of extended limb necrosis/gangrene results were poor. In such patients primary closure of the access must be discussed.

Banding under blood flow control resulting in an approximately 50% reduction in the initial blood flow is an adequate therapeutic option in patients with brachial HA and type I-DASS. In type II-DASS, banding does not lead to satisfying results, more complex surgical options might be more successful. Diabetes is associated with poor HA outcome in case of DASS.

In addition to steal phenomenon (stage I), which can be treated conservatively, there are three stages of DASS following autogenuous HA that require surgical intervention (stage II, no acral lesions; stage III, small acral lesions; stage IV, extended acral lesions). HA banding leads to good results in stage II; in patients with stage III, interruption of the retrograde flow is indicated. However, in patients with extensive tissue loss (stage IV), closure of the HA should be considered.