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<h2>Abstract</h2><h3>Objective</h3> The aim of this study was to evaluate this center's experience with treatment of aortic graft infection using neoaortoiliac system (NAIS) in situ reconstruction with a focus on long-term outcomes to better understand the optimal management of this devastating complication and add to limited existing research. <h3>Methods</h3> A retrospective chart review over 10 years (2012-2022) of patients who underwent graft explant with simultaneous NAIS for aortic graft infection. Short- and long-term outcomes were collected within 30 days and 5 years of the operation, respectively. Outcomes were compared based on operative microbiology results. <h3>Results</h3> Twenty-three patients were included, with an average age of 63.1 years (standard deviation, 12.3 years). The most common index operation was aortobifemoral bypass (n = 11; 48%), followed by endovascular aneurysm repair (n = 9; 39%), tube graft (n = 2; 8.6%), and aortobifemoral-iliac bypass (n = 1; 3%). The average time to graft infection was 4.42 years. Sepsis was the most prevalent presenting complaint (n = 9; 39.1%), and almost three-quarters of the patients had positive preoperative blood cultures (n = 17; 73.9%). Operative cultures were positive in 74% and polymicrobial in 47.8%. There were zero intraoperative deaths, with a 30-day mortality of 21.7% (n = 5). Gram-negative or polymicrobial operative microbiology was associated with a significant increase in the composite short-term outcome of mortality, reoperation, and major adverse cardiac events with an odds ratio of 8.75 (95% confidence interval, 1.24-61.7). Average follow-up was 41.7 months, with a 5-year survival of 60.1% and reintervention rate of 41.1%. Primary and primary assisted patencies were 82.4% and 88.2%, respectively. There was no difference in survival found between patients with gram-negative or polymicrobial infections and those without. <h3>Conclusions</h3> The high perioperative mortality and low 5-year survival of the cohort are in keeping with prior literature. Patients with polymicrobial or gram-negative operative cultures had worse short-term outcomes, but long-term outcomes did not differ based on identified pathogen. Further research is needed to create a larger cohort of this rare procedure and to compare it with other reconstructive options for aortic graft infection.