Surgical reconstruction for superior vena cava syndrome following pacemaker lead implantation

Pacemaker-related superior vena cava (SVC) syndrome, caused by fibrosis along pacemaker leads, was identified in a 65-year-old woman with chronic renal failure and atrial fibrillation. Initial management with two vascular bypass grafts failed due to thrombosis, resulting in symptom recurrence. Surgical intervention was subsequently performed, involving SVC reconstruction below the azygos vein with a pericardium patch and concurrent tricuspid valve repair. This case illustrates the challenges associated with pacemaker-induced SVC syndrome and demonstrates the potential advantages of reconstructive surgery, which, by restoring venous anatomy, may improve long-term outcomes when performed in an experienced center.