Venous insufficiency in pacemaker arm

I have developed venous insufficiency in my right arm, the same side where my pacemaker is implanted (and my dominant arm.)  Symptoms that led to that diagnosis were: purplish tint to my arm, feelings of heaviness in my arm, bulging veins on the inside wrist and occasional numbness in my right hand. I also had bruising on the upper arm that has not resolved after 4 weeks. I saw both my internist and cardiologist when this first occurred about 3 weeks ago.

My pacemaker was implanted last June because of complete heart block. The right side was chosen because I have a persistent left vena cava in my heart which contraindicates placement of the pacemaker on that side.  
i have obvious veining over the pacemaker which I have been told is my body's attempt to revascularize my arm (?)

I have been instructed to wear a compression sleeve and perhaps pursue moving ths pacemaker.  I would like to avoid that but do not want to compromise the blood flow from my arm. The compression sleeve minimizes the arm discoloration but my hand still often is bluish or red.  

i have an appointment with a vascular surgeon in February.  If anyone has any experience or insight into this, I would appreciate your thoughts.


2 Comments

Venous insufficiency

by Julros - 2022-01-10 22:18:21

I have something similiar, and my doctor's response was "so what, this is a common after effect. We told you about the risks." 

About 10 months after implant, my son pointed out that one of my arms was bigger than the other, and darker in color. And I was having daily headaches. My cardiologist ordered an ultrasound that showed subclavian vein stenosis, and said the above, through the nurse. I never actually spoke to him in person. I had more questions so they gave me a referral to a vascular surgeon. This guy said the same thing, that my subclavian vein had scarred around the pacing wires, impeding venous blood flow. Plus told me it wasn't that noticable, although coworkers and other family noticed it. The visible veins on my chest over the pacer are collateral circulation, to allow venous blood to return to my heart. He didn't think the headaches were related. He said there was no fix without messing up the wires. He said the changes I saw were permanent and I could wear a compression sleeve if I wanted. And he said I should be happy because it wasn't life or death. 

The swelling has gone down some, but you can see it if I hold my arms together. And the affected arm is slightly duskier, and the veins over the pacer are visible. The headaches finally stopped after 4 months. My new EP that I established care with noticed the difference in my arms immediately without me saying a word. 

Thanks

by Francophone - 2022-01-11 17:55:20

Thanks for sharing your experience.  I wish your doctor had been more sympathetic.  It may be a known risk and nothing frightening to him, but when it hsppens to you, the patient, it certainly can be worrying. 
It is helpful to hear that no drastic action was needed.  I am hoping that will be my outcome too.  I have heard they can move the pacemaker to the abdomen but assume that would require new leads and is likely subject to complications too.

After my PM implant in June, I developed a blood clot in my left ventricle.  I was in the hospital for 9 days for that.  Every morning when I wake up I am grateful that I am not in a hospital, but at home.  I really want to avoid any further surgery if possible.

Keeping my fingers crossed.

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