Superior Vena Cava Syndrome Immediately After Transvenous Lead Extraction

Background Superior vena cava syndrome is recognized as a complication of cardiac implantable electronic devices, usually resulting from a chronic venous obstruction related to transvenous leads. However, acute presentation is uncommon and may represent a diagnostic and therapeutic challenge.Case summary A 45-year-old man with long-standing pacemaker dependency due to complete heart block underwent transvenous lead extraction due to pacing-induce cardiomyopathy. Shortly after the procedure, he developed facial edema and cyanosis. Imaging revealed chronic right axillary vein thrombosis and acute-on-chronic left subclavian vein thrombosis associated with abandoned leads. Management included temporary femoral pacing, lead removal, serial venous angioplasty, and subsequent leadless pacemaker implantation, with favorable clinical outcome.Discussion This case highlights acute superior vena cava syndrome as a rare but important periprocedural complication of lead extraction, particularly in patients with high lead burden and preexisting venous disease. Prompt diagnosis and multidisciplinary management are critical to achieve successful outcomes.Take-home message Acute superior vena cava syndrome may occur shortly after transvenous lead extraction procedures.