Massive upper extremity edema with arteriovenous fistula for hemodialysis. A complication of previous pacemaker insertion.

A 50-year-old patient with chronic renal insufficiency developed massive edema of the left upper extremity following placement of an elective radial artery-cephalic vein fistula for future hemodialysis. Subclavian vein thrombosis was diagnosed by radionuclide venography and was undoubtedly caused by prior transvenous pacemaker insertion. Ablation of that fistula relieved the edema. Investigation of the circulation of extremities used for previous pacemaker insertion is advised prior to their employment as vascular access for hemodialysis.