Engorged Serpentine Veins Across Pacemaker Scar

Jun Kim, Jeong Su Kim, Yong Hyun Park, June Hong Kim, Kook Jin Chun
2011 Korean Circulation Journal  
The authors have no financial conflicts of interest. cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. A 79-year-old man presented with swelling of the left arm. He had undergone implantation of single chamber ventricular pacemaker for
more » ... ment of atrial fibrillation with slow ventricular response 34 months before presentation. Physical examination was notable for multiple serpentine veins across the pacemaker incision scar (Fig. 1) . Venography of the left arm showed occlusion of the left subclavian vein and tortuous collateral veins (Fig. 2) . The patient declined further investigation or invasive treatment. Subclavian vein occlusion occurs from 3.6 to 9.0% after implantation of a cardiac rhythm device. 1)2) Engorged veins over the anterior chest wall can be caused by stenosis or oc-clusion of the superior vena cava or subclavian vein. Engorged veins over anterior chest wall should raise the possibility of subclavian vein occlusion especially in patients with preexisting cardiac rhythm device. REFERENCES 1) Korkeila P, Nyman K, Ylitalo A, et al. Venous obstruction after pacemaker implantation. Pacing Clin Electrophysiol 2007;30:199-206. 2) Haghjoo M, Nikoo MH, Fazelifar AF, Alizadeh A, Emkanjoo Z, Sadr-Ameli MA. Predictors of venous obstruction following pacemaker or implantable cardioverter-defibrillator implantation: a contrast venographic study on 100 patients admitted for generator change, lead revision, or device upgrade. Europace 2007;9:328-32. Fig. 2. Venography of the left arm shows total occlusion of the left subclavian vein with multiple collateral veins together with a single lead pacemaker. Fig. 1. Multiple engorged veins with serpentine course are seen from the left axilla to the medial portion of the clavicle across the pacemaker incision scar.
doi:10.4070/kcj.2011.41.9.563 pmid:22022336 pmcid:PMC3193052 fatcat:dlbw6yjs45exzgpjemisbx5u2y