In a series of 342 arterial reconstructions of the iliacolic to popliteal arteries 24 patients with lymph vessel damage were observed. The diagnosis of lymphedema was established in 18 patients by clinical findings and in 2 of them the diagnosis was confirmed by lymphography with followup of 1 year. Three patients developed an internal lymphogenic cyst, 3 showed an external lymph fistula, and 1 patient developed an infection of a dacron bifurcation graft. The infection occurred when an additional occlusion of the left femoral artery was bypassed with an autologous saphenous vein graft and a lymph cyst in the groin, which was excised several times, became infected. The patient was treated successfully by excising the graft and performing an axillofemoral bypass. Although cases of surgical damage to lymph vessels following arterial reconstructions are rare in the literature, it is assumed that this complication occurs more often than reported, because of lack of lymphographic information.