Surgical management of superior vena cava syndrome following pacemaker lead infection: a case report and review of the literature

Abstract

Superior vena cava (SVC) syndrome is a known but rare complication of pacemaker lead implantation, accounting for approximately less than 0.5% of cases. Its pathophysiology is due to either infection or endothelial mechanical stress, causing inflammation and fibrosis leading to thrombosis, and therefore stenosis of the SVC. Due to the various risks including thrombo-embolic complications and the need to provide symptomatic relief, medical and surgical interventions are sought early. We present the case of a 48-year Caucasian male who presented with localised swelling and pain at the site of pacemaker implantation. Inflammatory markers were normal, but diagnostic imaging revealed three masses along the pacemaker lead passage. A surgical approach using cardiopulmonary bypass and circulatory arrest was used to remove the vegetations. Culture from the vegetations showed Staphylococcus epidermidis. The technique presented here allowed for safe and effective removal of both the thrombus and infected pacing leads, with excellent exposure and minimal post-procedure complications.

Iatrogenic Superior Vena Cava Syndrome after Cardiopulmonary Bypass Diagnosed by Intraoperative Echocardiography

“…Most cases of SVC syndrome are caused by thoracic malignancies, but there are an increasing number of cases due to benign causes, primarily via thrombosis secondary to semipermanent catheter or pacemaker placement. SVC syndrome following pacemaker placement often occurs secondary to the formation of vegetations or via thrombosis after endothelial disruption [ 2 , 3 ]. It has been found that up to 40% of SVC syndrome cases are due to benign causes that are most often iatrogenic [ 4 ].…”

Chylothorax and chylopericardium as unusual manifestation of pacing lead related complication

“…1 Pathogenesis is probably related to the inflammatory mechanism leading to endovascular fibrosis and thrombosis. 2 In the presented case, occlusion of brachiocephalic veins by the pacemaker leads, with superimposed thrombosis, probably initiated a cascade of events that resulted in chylous leakage. The substrate of venous and lymphatic circulation disorders was lead related infection developing secretly on the side of the abandoned lead.…”

Facial flushing on upper limb exertion: a rare presentation of superior vena cava obstruction

“…Although SVC obstruction is a known complication of chronically implanted vessels in the absence of infection, pacemaker lead infection has been implicated in the pathogenesis of SVC obstruction by inducing inflammation and subsequent fibrosis and through mechanical obstruction by thrombus . We suspect that infection played a role in the development of SVC stenosis in this case.…”