Lymphedema results in a variety of symptoms such as pain, paraesthesia, heaviness, and, edema [
25,
26]. The size difference of limbs makes daily life difficult and also might be disfiguring for the patient [
27,
28]. Lower limb lymphedema also has been reported to negatively impact physical activity and to be associated with sleep disturbances which reduce the quality of sleep and QoL [
29,
30]. The role of pain in distressing QoL is well-documented in the literature and depression and anxiety disorders are clinically important comorbidities among lymphedema patients [
31]. In our case, the man has been experiencing many of the mentioned problems, however, there is one aspect of this case that needs to be highlighted: It took two years for him to find out the name of his disease. This frustration has imposed a significant burden on him. He willingly tried many different complementary and alternative therapies with no effect. Diuretics also have been tried with no improvement in his situation. It is important to distinguish lymphedema from possible differential diagnoses such as congestive heart failure, chronic venous diseases, and, lipedema [
32]. Although the diagnosis could be challenging at his age accounting for his cardiovascular history, some clinical signs and symptoms could be useful to make such a distinction. The unilateral limb edema with a positive Stemmer sign and a normal Doppler ultrasonography is strongly suggestive of lymphedema. Making the right diagnosis is related to the knowledge of healthcare providers and there is a substantial gap in this field [
33,
34]. Lymphedema is somehow neglected in medical research and education and the outcome of this neglect would reflect on clinical practice [
35‐
37]. Knowledge of lymphedema is essential to take preventive measures and reduce the risk of lymphedema development following saphenous harvesting surgery. New research is directed to minimally invasive surgical techniques for saphenous harvesting. The study by Cisowski et al. compared three less invasive surgical techniques with the open surgery of saphenous vein harvesting. In this prospective randomized trial, endoscopic harvesting was used by different techniques as minimally invasive surgery for saphenous harvest. After seven days post-operation, the number of patients with edema was significantly lower among three arms compared to the open surgery. Other outcomes such as wound healing or pain were also better among patients who received endoscopic surgery [
38]. Šimek et al. reported similar results in their prospective trial comparing minimally invasive and endoscopic great saphenous harvesting. Lymphatic discharge was significantly lower among the endoscopic group at seven days post-operation. Also, residual edema was significantly lower both at seven and three months follow-up after endoscopic surgery [
39]. Additionally, early rehabilitation to restore lymphatic drainage is another means to prevent lymphedema following saphenous harvesting surgery but unfortunately, his lymphedema was not diagnosed and he was not referred to the specialized center for lymphedema management. Interestingly, he has performed four Doppler ultrasonography during the past two years which all were normal. These are all indicators of direct and indirect costs of lymphedema which burden healthcare systems. Such costs also could play a role in disturbed QoL [
40,
41]. Recognizing lymphedema in the field of cardiovascular surgery is one way to prevent such unnecessary costs.