A 35-year-old male developed superior vena cava (SVC) obstruction due
to multiple retained pacemaker leads, This caused cyanosis and suffusi
on of the head and neck during arm exercise, with desaturation from 99
%-90% demonstrated by ear oximetry. The SVC was bypassed using a spira
l vein graft because of worsening symptoms. Dramatic improvement resul
ted, with desaturation no longer demonstrable.