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Review
. 2014 Jun 19:9:107.
doi: 10.1186/1749-8090-9-107.

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

John Kokotsakis, Umar A R Chaudhry, Dimitris Tassopoulos, Leanne Harling, Hutan Ashrafian, Michail Vernandos, Meletis Kanakis, Thanos Athanasiou  1
Affiliations
Review

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

John Kokotsakis et al. J Cardiothorac Surg. .

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.

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Figures

Figure 1
Figure 1
Transverse plane image of contrast-enhanced CT scan demonstrating two pacemaker leads within the SVC.
Figure 2
Figure 2
Cannulation of the innominate vein.
Figure 3
Figure 3
Extracted pacemaker leads.
Figure 4
Figure 4
Extracted thrombus.
Figure 5
Figure 5
Post-operative 3-dimensional CT-imaging demonstrating complete clearance the SVC obstruction.
See this image and copyright information in PMC

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