Background: The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) is a major threat in arterial surgery and poses a considerable therapeutic challenge. The aim of this study was to assess the prevalence of MRSA infection in patients treated in the vascular unit. Methods: A retrospective case-note review was undertaken to identify the nature of the infection and the outcome. Results: During 1993–1998, a total of 115 patients (4 per cent of the total) were positive for MRSA. Of these, 67 were colonized and 48 were infected by MRSA. The number of MRSA infections increased yearly (1 per cent in 1994 to 5 per cent in 1998). Of the 48 patients infected by MRSA, one had wound infection following brachial embolectomy which eventually resolved. Two patients had undergone carotid endarterectomy necessitating removal of an infected Dacron patch, one of whom developed a hemiparesis. Eleven patients had undergone elective abdominal aortic aneurysm (AAA) repair (five developed pneumonia, two septicaemia, two wound infection, one a false aneurysm at the site of insertion of an endovascular stent, and one developed crossover graft infection after endovascular AAA repair and died). Five patients had undergone ruptured AAA repair (two developed pneumonia, one wound infection and two developed graft infection and died). Four patients undergoing reconstruction for aortic occlusive disease developed MRSA infection, two of whom died. Twenty-five patients with MRSA infection had undergone lower limb procedures. Five of these had graft infection leading to amputation in three and death in two. One patient developed primary arterial infection following embolectomy resulting in arterial rupture. Conclusion: These results suggest that the prevalence of MRSA infection in vascular patients is increasing. Infection of aortic grafts appears to be uniformly fatal and lower limb graft infection is associated with a high rate of limb loss.