Superior vena caval syndrome (SVC) following transvenous pacemaker insertion is an uncommon complication that has been treated with percutaneous transluminal balloon angioplasty. We report a case of SVC syndrome following pacemaker implantation that was treated with angioplasty. Several days after the initial balloon dilation, the patient had recurrent symptoms and evidence of restenosis on catheterization. Following repeat balloon dilation of this restenotic lesion, the patient had a favorable clinical response evidenced on hemodynamic and angiographic follow-up at 6 months. © 1995 Wiley-Liss, Inc.