Absence of the superior vena cava: difficulties for pacemaker implantation

Area of Science:

• Cardiology
• Medical Device Technology
• Vascular Anatomy

Background:

• Endocardial pacemaker electrode implantation presents challenges in patients with anomalous superior vena cava (SVC).
• Anatomical variations in venous drainage require tailored surgical approaches for device placement.

Observation:

• Diagnostic imaging (venography and CAT scan) revealed a complete absence of superior vena cava (SVC) venous drainage.
• Systemic venous return was exclusively via the azygos vein into the inferior vena cava.

Findings:

• A temporary pacemaker electrode was successfully placed via femoral vein puncture.
• Permanent pacemaker lead implantation was achieved through venotomy of the epigastric vein, utilizing the external iliac vein for access.

Implications:

• This case demonstrates a feasible alternative strategy for pacemaker implantation in complex SVC anomalies.
• Successful implantation via the epigastric vein approach offers a potential solution for patients with challenging venous anatomy.
• Highlights the importance of thorough pre-procedural imaging for planning pacemaker lead placement in anomalous venous systems.