The experience with 14 patients with infected aortic bifurcation grafts was reviewed. Factors which appeared to predispose to infection in 11 patients included re-do operations, concomitant cholecystectomy or gastrostomy and ruptured abdominal aneurysm. A mixture of gastrointestinal organisms was responsible for the infections. The pathogenesis, presentation and treatment varied according to whether the proximal or distal anastomosis was involved. Aortoduodenal communications were present in 5 patients; they presented with gastrointestinal bleeding or septicemia. One patient survived as a result of early, aggressive surgical therapy. Infection presented at the distal anastomosis in 9 patients, as groin abscess or false aneurysm. Conservative therapy failed in the majority of patients but apparently was successful in 3 of 5 patients in whom infection did not involve the intra-abdominal portion of the graft. When infection does involve the intra-abdominal portion of the graft, then the graft must be excised also. Revascularization often can be accomplished with extra-anatomic bypasses of prosthesis or autogenous material, depending on the characteristics of the individual patient. Regardless of the mode of presentation or the site of infection, the early institution of judicious surgical management offers the best chance of success in these patients, and temporization usually leads to failure.