Pacemaker Lead Induced Inferior Vena Caval Thrombosis Leading to Portal Hypertension

Inferior vena caval thrombosis is an unusual complication of permanent pacemaker implantation. The clinical presentation due to thrombosis depends on the site of thrombus. We have described here a rare case of pacemaker lead associated thrombosis of inferior vena cava, its diagnostic work up and briefly reviewed the existing literature of this uncommon complication. Case Report A 40 year old male had a history of single chamber permanent pacemaker implantation (VVIR) in 2001 for complete heart block. As the patient was young, basic investigations were done at that time to exclude auto- immune and infiltrative diseases. Tests for Anti nuclear antibody (ANA), anti phosoholipid antibodies (APLA) and Rheumatoid factor were negative. In 2008, he was detected to have ERI (Emergency Replacement Indicated) and re-implantation was done with the change of pulse generator and pacing lead as lead impedance was high. The old lead was left in situ. After 4 years, he presented in our department with gradually progressive dyspnoea, bilateral pedal oedema and abdominal distension. At the tim