Superior Vena Cava Syndrome Caused by Pacemaker Leads

Abstract

Superior vena cava syndrome is one of the rare adverse events associated with pacemaker leads. We describe a 47-year-old woman with a pacemaker implanted 10 years earlier who presented to us with superior vena cava syndrome managed surgically. We report the presentation, diagnosis, and treatment of this patient and the causes and management options of superior vena cava obstruction associated with pacemaker leads.

Superior vena cava syndrome due to pacemaker leads: an Indian report with a review of management practices

“…Though SVC syndrome due to pacemaker lead has been reported worldwide, a search of PubMed, IndMed and other databases revealed that it has been previously reported only once from India [4]. The authors reported a 47-year-old female who underwent transvenous pacemaker implantation for sick sinus syndrome.…”

“…Lead extraction alone may cause development of large intimal flaps and thrombosis, leading to restenosis. Patients with SVC obstruction refractory to endovascular treatment can undergo surgical interventions such as a SVC bypass using a spiral saphenous vein conduit or the reconstruction of the SVC using a pericardial patch followed by the epicardial pacing [4]. In a retrospective review of the treatment practices from 74 published studies comprising 104 patients, it was seen that the main treatment modality was anticoagulation in 29/104 patients.…”

“…SVC syndrome due to the presence of pacemaker leads is a diagnostic rarity with just a single case being reported in the literature from the Indian subcontinent [4]. In addition, a lack of definite treatment strategy for this entity further leads to inadequate and inappropriate management.…”

Innominate Vein Injury Secondary to First-Time Sternotomy

“…The presence of transvenous leads themselves has been shown to cause fibrosis within the vein, which may be transmural, involving the adventitia and surrounding tissues. 4,5 We also wonder whether the left innominate vein would have been less likely to be injured if we had divided the sternum starting at the xiphoid with a bottom-up approach, as opposed to our top-down approach starting at the sternal notch. Is it possible that the superior but not the inferior aspect of the left innominate vein was adherent to the posterior manubrium?…”

Acute Hemodynamic Compromise Following Superior Vena Cava Stent Placement: a Case Report

“…The prevalence of SVC syndrome has grown with the advent of increased implantable cardiac medical devices or long-term tunneled central intravascular access, which can result in acute thrombosis, culminating in SVC syndrome. [3,4] Adenocarcinoma of the lung is probably the most common cause of SVC syndrome seen in malignant diseases [5]. Other conditions which may cause SVC syndrome are secondary to infection such as tuberculosis or syphilitic aortic aneurysm [6].…”