An unexpectedly high frequency of ventral incisional hernia in our aortic reconstruction patients prompted us to review a recent three year period. Of 76 aortic reconstruction patients, 66 were evaluable for at least one year following their aortic procedure. In these 66 patients, ventral incisional hernias occurred in 14 (21.2%). Of statistical significance (P less than .01) was that ten of the 14 hernias occurred in the 27 aneurysm patients (37%) and four occurred in the 39 occlusive disease patients (10%). Though a comparison group of aneurysm patients is not available in the literature, the incidence of hernia in our occlusive disease population is consistent with the literature experience when careful long-term follow-up is employed. These observations may represent another manifestation of previously reported differences between aortic aneurysm and occlusive atherosclerotic populations.