Introduction: Aortic graft infections (AGI) and mycotic aortic aneurysms (MAA) are life-threatening conditions, and while they represent distinct pathologies, current guidelines describe similar management in both. However, it is unclear to what extent these two groups differ in patient profile, presentation, and outcomes, and if so whether the same management should be used. Methods: We conducted a retrospective cohort study across four centres in New Zealand. Patients with AGI or MAA from 2005-2023 were identified using the AVA registry and hospital databases. Baseline characteristics, presentation, operative, and outcome data were collected. Descriptive statistics were analysed using chi-squared and t-tests. Kaplan-Meier and Cox age-adjusted survival analyses were performed. Results: 157 patients included (99 AGI [69±12y,82%m], 58 MAA [69±11y,65%m];p=0.89 age, p<0.02 sex). The MAA group had more diabetes while the AGI group had more PAD (p<0.05), but the groups were otherwise similar (p>0.08). Most patients presented with pain and/or fever, with higher rates of pain in MAA (86v60%,p<0.01). Endovascular treatment was more common in MAA (47v23%,p<0.01) and non-operative in AGI (28v5%,p<0.01), while open was similar (p=0.57). 30d (86% AGI/93% MAA) and 1y survival (70% AGI/78% MAA) did not differ (p>0.17), including on Kaplan-Meier analysis (p=0.66), nor when stratified by management approach (p>0.05). Conclusion: This national study shows that AGI and MAA are morbid conditions. AGI more frequently affected males and those with peripheral arterial disease, while those with MAA were more likely to have diabetes and pain. There were higher rates of endovascular treatment in MAA. Patients with AGI were more likely to be managed non-operatively than in MAA. While AGI and MAA have similar treatment guidelines, these entities differ in their presentation and management. Despite this, survival was similar, supporting an individualised approach towards decision making.