Explantation of infected kissing iliac stents complicated by acute discitis with aortoiliac reconstruction: a case report

Introduction: Endovascular therapy for aortoiliac occlusive disease (AIOD) has the benefits of being minimally invasive with reliable patency outcomes. The VIABAHN VBX Balloon Expandable Endoprosthesis is widely used for iliac interventions; however, infection of such devices is exceptionally rare and its clinical course poorly characterised. Case presentation: A 55-year-old man with a history of mucosa-associated lymphoid tissue lymphoma presented with lifestyle-limiting claudication due to left common iliac artery occlusion. Following multidisciplinary team (MDT) review, he underwent successful percutaneous kissing iliac stenting using VBX endoprostheses. One week later he re-presented with new onset back pain and left leg swelling. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) demonstrated focal tracer uptake around the left iliac stent with maximum standardised uptake value (SUVmax) 10.6, and blood cultures grew Staphylococcus epidermidis. Despite intravenous antibiotics, the pain worsened and repeat PET/CT revealed progression (SUVmax 15.6) and L4 vertebral erosion consistent with discitis and osteomyelitis. Management and outcome: Following MDT consensus, both stents were explanted and the aortoiliac segment reconstructed in situ with a custom bifurcated graft fashioned from bovine pericardium. Cultures confirmed S. epidermidis. Guided by susceptibility testing and European Society for Vascular Surgery recommendations, ceftriaxone (2 g IV daily) and rifampicin (600 mg orally daily) were administered for 10 weeks. Serial MRI demonstrated resolution of the 26 × 19 mm prevertebral abscess and regression of inflammatory changes. At six-month follow-up the patient remained infection-free with restored mobility, reporting only retrograde ejaculation – recognised consequence of open aortic surgery. Conclusion: This appears to be the first documented infection of a VBX endoprosthesis complicated by early vertebral discitis. Rapid diagnosis through multimodal imaging and coordinated surgical–infectious disease management enabled cure. Clinicians should maintain vigilance for this rare but severe complication, particularly in immunocompromised patients.