title: 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.
authors.forename: John
authors.initials: J
authors.lastname: Kokotsakis
authors.forename: Umar A R
authors.initials: UA
authors.lastname: Chaudhry
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tassopoulos
authors.forename: Leanne
authors.initials: L
authors.lastname: Harling
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.forename: Michail
authors.initials: M
authors.lastname: Vernandos
authors.forename: Meletis
authors.initials: M
authors.lastname: Kanakis
authors.affiliation: Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London W2 1NY, UK. t.athanasiou@imperial.ac.uk.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D020878:Device Removal / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000382:microbiology; D012804:Sick Sinus Syndrome / Q000628:therapy; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed