Ischemic monomelic neuropathy (IMN) is recognized as a rare ischemic neuropathy caused by vascular access originating from the brachial artery leading to hemodialysis. IMN is characterized by acute painful muscle weakness shortly after surgery and neuronal axon loss without necrosis of adjacent tissues. In chronic diabetic patients with polyneuropathy, brachial vascular access surgeries include the risk of IMN, necessitating immediate surgical treatment such as banding or ligation. In the above case, we chose to close brachial-cephalic arteriovenous fistula for IMN with no short-term neurologic improvement, however, significant neurological and clinical improvement was observed in long-term follow-up. Here, we present a case of IMN with serial nerve conduction evaluations indicating the improved long-terms outcomes.