Deep venous thrombosis is extremely rare after arthroscopic shoulder surgery. In this report, we describe one such case in a patient with a history of cardiac pacemaker placement. He presented with complaints of pain and swelling in the operated extremity several days after rotator cuff surgery and underwent ultrasound evaluation that confirmed thrombosis of the axillary vein with extension into the brachial and basilic veins, down to the level of the elbow. He was treated with Coumadin, as well as enoxaparin (Lovenox) at therapeutic dosages until INR levels were in the therapeutic range. Follow-up ultrasound at 6 months demonstrated successful recanalization of the affected vessels and no further complications were noted. This is the first report we are aware of that documents axillary vein thrombosis in the setting of arthroscopic shoulder surgery. Though the patient had several risk factors for hypercoagulability, including diabetes and hypertension, we suggest that his cardiac pacemaker leads may have contributed to a thrombogenic environment and cite medical literature that reports an association with thrombosis in the axillary and subclavian veins with pacemakers and defibrillators.