1.50 year-old hospitalized female with end-stage renal disease (ESRD) on intermittent HD with a left upper extremity AV graft reported ipsilateral arm and hand pain with numbness.

2.Vascular Surgery consultation determined patient’s AV graft had arterial stenosis and DASS, which were likely the cause of patient’s symptoms.

3.No immediate diagnostic or surgical interventions were deemed necessary at the time by surgical team.  Patient was scheduled for outpatient follow-up after discharge from hospitalization.

4.Acute Pain Service was consulted given persistent pain despite pharmacotherapy.

5.Patient consented to a stellate ganglion block, which was performed during hospitalization.  She reported significant resolution of her pain and mild improvement in numbness for 48 hours and at hospital discharge.

•HAIDI can be a significant source of morbidity for patients who require AV access and develop complications as a result.

•HAIDI may sometimes be prohibitive for dialysis treatments as patients with advanced disease may experience intolerable pain during periods of significant fluid shift (i.e., dialysis)2.

•HAIDI is definitively managed with surgical intervention, which necessitates pre-operative diagnostic imaging and vascular studies.  Inadequate pain control can be a source of morbidity pending surgical workup.

•No literature is available for regional anesthesia techniques for this specific vascular pathology.

•In our experience, ultrasound-guided stellate ganglion blockade was a safe, effective and efficient technique for pain relief from vascular insufficiency due to HAIDI while awaiting definitive treatment.