Inferior vena cava obstruction secondary to permanent pacing

A 74-year-old man presented with severe swelling of the abdomen, and legs 2 2 years after pacemaker implantation. Contrast CT and an intra-venous cavog ram showed occlusion of the inferior vena cava (IVC) from the level of the left renal vein to the liver. He died 26 days after admission, of a low out put state. Post mortem examination revealed two pacing wires deeply embedde d in fibrous tissue in the right atrium, causing moderate stenosis of the s uperior vena caval orifice into the right atrium and very severe stenosis o f the inferior vena caval orifice down to 4 mm. We believe that this unique case was due to an ideopathic reaction to a cut pacing lead and an exagger ated loop in the second lead. (C) 2000 Elsevier Science Ireland Ltd. All ri ghts reserved.