Ischemic monomelic neuropathy is an uncommon complication associated with the creation of arteriovenous (AV) fistula for hemodialysis. After placement of an arteriovenous fistula, there can be shunting of arterial blood away from the distal extremity resulting in damage to distal nerve fibers with acute neurologic symptoms. It can present with global muscle pain, weakness, and a warm hand with palpable pulses starting within the 1 st h after the creation of the AV fistula. It is a devastating complication and can result in permanent disability. We hereby report two cases of ischemic monomelic neuropathy associated with the creation of a brachiocephalic AV fistula for hemodialysis access.