Hemodialysis access-induced distal ischemia ( HAIDI ) is an uncommon, yet potentially devastating, complication of hemodialysis access surgery. Management of HAIDI depends on the access' volume flow and may involve banding, proximalization of arterial inflow, revision using distal inflow, distal revascularization interval ligation, or access ligation. Various adjunctive techniques have been used to confirm improved distal arterial flow intraoperatively. Here, we present a case of a patient with grade 3 HAIDI treated with proximalization of arterial inflow technique with the adjunctive use of intra-arterial pressure gradient measurements.