Contralateral Replacement of Pacemaker and Leads Following Laser Sheath Extraction and Concomitant Stenting for Superior Vena Cava Syndrome

Abstract

We present the case of a 61-year-old man with a history of pacemaker implantation 15 years ago. The patient was admitted with chronic swelling of the right hemithorax and inflammation of the old incision scar after the replacement of pacemaker generator 6 years ago. The patient also presented symptoms and clinical signs of superior vena cava syndrome. Computed tomography of the thorax showed obstruction of the superior vena cava. The surgical procedure consisted of extraction of infected pacemaker system with excimer laser technique followed by dilatation and stenting of the SVC and finally implantation of a new permanent pacemaker system on the left side.

Managing Superior Vena Cava Syndrome as a Complication of Pacemaker Implantation: A Pooled Analysis of Clinical Practice

“…Based on the specified criteria, we identified 104 qualifying patients from 74 different publications, published from 1970 through 2009 (see Table S1) 1,2 , 4–76 . Of the 104 patients (55 men, 39 women, 10 unspecified), the mean age (±standard deviation) was 59 (±14) years old.…”

Short-term Venous Patency after Implantation of Permanent Pacemakers or Implantable Cardioverter Defibrillators

“…Although high rates of subclavian vein stenosis after pacemaker implantation have been reported, the incidence of clinical manifestations such as upper limb edema is relatively low at about 5%. 10,11,14,16,26) In the present study, during the acute stage within 1 week after surgery, 6 of the 7 patients with a venous occlusion developed upper limb edema and/or subcutaneous bleeding; however, one patient had no clinical manifestations. Furthermore, some patients with superior vena cava syndrome, have not been reported to have any symptoms.…”

Surgical Lead Extraction for Total Occlusion of the Superior Vena Cava by Chronic Lead Infection After Mustard Procedure

“…The development of venous collaterals may reduce the blood flow in the SVC promoting further extension of thrombosis and SVC occlusion. Other important risk factors for thrombosis of the SVC are local infection, pacemaker implantation, or the presence of multiple pacemaker leads . Infection of pacemaker leads is probably the most serious cause of SVC occlusion and is associated with high morbidity and mortality rates up to 66% when infected leads are not removed .…”

“…Other important risk factors for thrombosis of the SVC are local infection, pacemaker implantation, or the presence of multiple pacemaker leads. [4][5][6] Infection of pacemaker leads is probably the most serious cause of SVC occlusion and is associated with high morbidity and mortality rates up to 66% when infected leads are not removed. 7 Although quite uncommon, pacemaker-related infections and endocarditis due to C. jeikeium represent a diagnostic and therapeutic challenge.…”