Superior Vena Cava Occlusion as a Complication of Transvenous Cardiac Device Implantation: A Case Report and Brief Review

Superior vena cava (SVC) syndrome is a rare complication of transvenous cardiac device implantation, which may lead to delay of diagnosis when symptoms appear. A 68 year-old male with a dual chamber implantable defibrillator implanted 10 years prior presented to an emergency department with symptoms of facial swelling, frequent headaches, and early morning purple facial discoloration. At UF Health, he underwent computed tomographic (CT) scanning of the chest which was consistent with SVC syndrome, presumably a complication related to the prior implantation of his cardiac device. Despite the imaging findings, venography remains the diagnostic modality of choice. Heparinization, catheter-based venography, and catheter thrombectomy with serial balloon angioplasty were performed for recanalization of the SVC, and the patient was ultimately discharged asymptomatic on apixaban for anticoagulation. However, symptoms recurred within two weeks. Ultimately, the patient underwent surgical right internal jugular vein to right atrial bypass with resolution of symptoms. A post-operative CT venogram was performed and the anastomosis was successful. Apparently an angiogram was not done at one year.