# Upper Limb Deep Vein Thrombosis Following Pacemaker Insertion: A Report of Two Cases

## TL;DR

This paper reports two cases of upper limb blood clots after pacemaker implantation, highlighting the importance of recognizing this rare but serious complication.

## Contribution

The paper adds to the clinical understanding of the variable timing and risk factors for upper limb DVT after pacemaker insertion.

## Key findings

- Two patients developed left upper limb DVT after pacemaker implantation at different time intervals.
- Ultrasound confirmed occlusive thrombi in the axillary and subclavian veins in both cases.
- DOAC therapy was effective in treating the DVT in both patients.

## Abstract

Upper limb deep vein thrombosis (DVT) has become a more common condition due to the growing use of cardiac device implantation. We report two cases of left upper limb DVT occurring five days and three months, respectively, after permanent pacemaker implantation. Both patients presented with progressive swelling of the left upper limb associated with dilated superficial veins across the left chest and upper arm. Ultrasound (US) compression venography confirmed occlusive thrombi in the left axillary and subclavian veins. They received direct oral anticoagulant (DOAC) therapy after the diagnosis. This case series highlights the variable timing of symptom onset following permanent pacemaker insertion and emphasises the other risk factors, such as essential thrombocythaemia, to the development of upper limb DVT.