A 50-year-old man with a history of type 2 diabetes mellitus, coronary artery disease, peripheral vascular disease, and severe vascular calcification underwent placement of a brachial artery to antecubital vein arteriovenous fistula (AVF) in his left arm after the diagnosis of end-stage renal disease. He first experienced hand claudication and erythema of his left hand and digits 14 months after surgery. Pain and coldness of the left hand increased gradually over a 4-month period, and weakness was noted on examination. Vascular steal created by the fistula was suspected; however, the patient had a history of bilateral ulnar neuropathy, carpal tunnel syndrome, and generalized sensory axonal polyneuropathy. Ligation of the fistula was delayed because no other site was available for long-term angioaccess. The patient subsequently began continuous ambulatory peritoneal dialysis.