Background Thoracic aortic graft infection (tAGI) is a rare complication of thoracic endovascular aortic repair (TEVAR), with limited data on prevalence, risk factors, and management strategies. We sought to assess the treatment strategies and outcomes from tAGI in a tertiary hospital. Methods This was a retrospective observational cohort study of cases of tAGI presenting to Waikato, Hospital from 2008-2024. Cases were identified using the Australasian Vascular Audit registry and individual hospital databases. Inclusion as a tAGI was as determined by the treating clinician. Baseline characteristics, presentation, management, and outcome data were collected. Results There were 39 aortic graft infections of all types identified from 2008-2024, of whom 6 patients had a tAGI, with a mean age of 62.0 years, 5 (83.3%) male, and 1 (16.6%) Māori. Fever was the most common presentation (all), followed by pain 5 (83.3%), while no patients presented haemodynamically unstable. The most common causative organisms identified on blood or tissue samples was Staphylococcal spp. 2 (33.3%) and Streptococcal spp. 2 (33.3%), with 1 case of combined Proteus and Propionibacterium, and 1 patient who had no microbial growth. The most common management strategy was non-operative 4 (66.7%), compared to endovascular 1 (16.7%), and open repair 1 (16.7%). 30-day survival was 83.3% and 1-year survival was 50.0%. Mean overall survival was 24.4 months. Conclusion This single-centre study demonstrates that tAGI is associated with significant morbidity and mortality. Fever and pain are the most frequent presentations. Non-operative graft preserving antimicrobial therapy was the most common management strategy.