Mycotic aortic aneurysms and infection of aortic grafts and endografts are dreaded complications of aortic disease that have been associated with high rates of major morbidity and mortality. Improved outcomes reported in recent years have been predicated on arriving at a timely diagnosis and developing an appropriate treatment plan after consideration of all options. This chapter will provide data to support a rational algorithm for the diagnosis of these challenging conditions. The various treatment options will be discussed, ranging from antibiotic therapy alone to complete resection of the infected aneurysm or graft with in situ or remote arterial reconstruction of the resected aortic segment. Various adjuncts to in situ repair of the aorta, such as antibiotic-impregnated grafts and omental flap coverage of prosthetic grafts, will be outlined. The relative advantages and pitfalls of each approach and their outcomes are reviewed. The goal of this chapter is to aid clinicians in the diagnosis and treatment of these difficult complications in order to minimize the risk of major morbidity or mortality.