Engorged Serpentine Veins Across Pacemaker Scar

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. A 79-year-old man presented with swelling of the left arm. He had undergone implantation of single chamber ventricular pacemaker for management of atrial fibrillation with slow ventricular response 34 months before presentation. Physical examination was notable for multiple serpentine veins across the pacemaker incision scar (Fig. 1). Venography of the left arm showed occlusion of the left subclavian vein and tortuous collateral veins (Fig. 2). The patient declined further investigation or invasive treatment. Subclavian vein occlusion occurs from 3.6 to 9.0% after implantation of a cardiac rhythm device.1)2) Engorged veins over the anterior chest wall can be caused by stenosis or occlusion of the superior vena cava or subclavian vein. Engorged veins over anterior chest wall should raise the possibility of subclavian vein occlusion especially in patients with preexisting cardiac rhythm device.