An 86-year-old woman was referred to our institution for pacemaker dysfunction (right ventricular complete lead fracture; Fig. 1 ). She had had double-chamber pacemakers (three device replacements) for complete atrioventricular block for 30 years. A new ventricular lead was inserted via a right subclavian vein puncture. One year later, she started complaining about swollen eyelids and bloating of the head. The physical examination was normal except for gross distension of the neck veins. Contrast enhanced computed tomography confirmed partial intravascular obstruction of the superior vena cava (SVC) due to possible thrombosis. Anticoagulation therapy with 10 days (heparin infusion followed by oral anticoagulants) failed to relieve the symptoms, which became progressively worse. General oedema of the upper body, increasing varicosities at the surface of the skin around the navel and large internal haemorrhoids were observed.
Superior venocavography showed proximal stenosis of the SVC with drainage via the azygous system ( Figs. 2 and 3 ). A self-expanding Wallstent ® (Boston Scientific Corp., Natick, MA, US), 6 cm in length, was inserted and deployed within the stenosis ( Fig. 4 ). The pacing electrodes were fixed between the wall of the SVC and the Wallstent ® ( Fig. 5 ). Subsequent angiography showed free flow of contrast into the right atrium ( Fig. 6 ).
