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Borg M, Swaminathan M, Cheuk J, Michael J, Walker G. Early endovascular retrieval of a migrated Implanon NXT from a branch of the right pulmonary artery. BMJ Case Rep 2024; 17:e261381. [PMID: 39142844 DOI: 10.1136/bcr-2024-261381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
A woman in her 20s was referred to a tertiary hospital emergency department for management of a migrating Implanon NXT. The Implanon was inserted 1 week prior by the patient's general practitioner who was unable to palpate the Implanon after insertion and hence, ordered an ultrasound scan which showed an actively migrating Implanon in the left basilic vein. She had mild chest pain, and her physical examination, ECG and blood tests were unremarkable. A CT chest showed a 31 mm foreign body within the right lower lobar artery. The foreign body was removed by interventional radiology by accessing the right internal jugular vein under ultrasound guidance and inserting a 6 FR pig catheter into the pulmonary trunk. The position was confirmed with angiogram and the foreign body was removed using a goose neck snare. The patient was discharged the same day with no complications, and fell pregnant a few months afterwards.
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Affiliation(s)
- Michelle Borg
- Obstetrics and Gynaecology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Griffith University, Brisbane, Queensland, Australia
| | - Mathusi Swaminathan
- Obstetrics and Gynaecology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Johnson Cheuk
- Obstetrics and Gynaecology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Joanne Michael
- Obstetrics and Gynaecology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Graeme Walker
- Obstetrics and Gynaecology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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2
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Guilbert É, Arguin H, Bélanger M. Migration of etonogestrel subcutaneous contraceptive implants: systematic review and recommendations for practice. EUR J CONTRACEP REPR 2024; 29:115-130. [PMID: 38712717 DOI: 10.1080/13625187.2024.2342919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/05/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Migration is a rare but serious complication of the etonogestrel contraceptive implant, and little is known about its extent. PURPOSE To document and characterise cases of etonogestrel contraceptive implant migration in the scientific literature. METHODS A systematic review of Medline, Embase and Global Health databases was carried out between January 2000 and January 2023 to identify articles presenting implant migrations. Narrative reviews, conference abstracts and articles not written in English or French were excluded. RESULTS Forty-five articles, mostly published since 2016, were identified (eight case series and 37 case reports), for a total of 148 independent cases of migration: in pulmonary blood vessels (n = 74), in non-pulmonary blood vessels (n = 16) and extravascular (n = 58). Many patients are asymptomatic and migration is often an incidental finding. A non-palpable implant and symptoms related to implant location (intra- or extra-vascular) may be indicative of migration. Inadequate insertion and normal or underweight appear to increase the risk of migration. Scientific societies and authors offer practical strategies to deal with implant migration. CONCLUSION Professionals who insert and remove contraceptive implants must be adequately trained. They need to be on the lookout for implant migration, and promptly refer patients to appropriate care if migration is suspected.
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Affiliation(s)
- Édith Guilbert
- Direction of the Development of Individuals and Communities, Quebec National Institute of Public Health, Montreal, Quebec, Canada
- Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, Laval University, Quebec, Quebec, Canada
| | - Hélène Arguin
- Direction of the Development of Individuals and Communities, Quebec National Institute of Public Health, Montreal, Quebec, Canada
| | - Mathieu Bélanger
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
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3
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Grange R, Magand N, Grand N, Leroy S, Corsini T, Azarnoush K, Grange S. Endovascular retrieval of a migrated contraceptive implant into the pulmonary artery : case report and review of literature. CVIR Endovasc 2024; 7:35. [PMID: 38581571 PMCID: PMC10998818 DOI: 10.1186/s42155-024-00450-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND The migration of contraceptive devices into pulmonary arteries is extremely rare, reported to be 1 in 100,000. CASE PRESENTATION A 19-year-old female presented no sensation of a contraceptive implant in her arm which had been placed one year prior. A CT scan confirmed that the implant had migrated into the left lower segmentary pulmonary artery. After a multidisciplinary meeting, an endovascular approach was attempted. Following right femoral venous access, a 8F NeuronMax® introducer was placed into the left pulmonary artery under fluoroscopic guidance. The contraceptive device was removed using a 25-mm loop snare, with a proximal capture technique. The patient was discharged the following day, with no reported complications. CONCLUSION In cases of contraceptive device migration, the first medical decision involves deciding between removal or 'watching and waiting'. Previous reports describe two removal options: endovascular or surgical approaches. Fourteen reports have been published, with high technical success and low rates of complications. The loop snare technique is described as the optimal technique for an endovascular approach. Due to their invasive nature, surgical approaches should be reserved for cases of endovascular removal failure, after evaluating risks and benefits.
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Affiliation(s)
- Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
| | - Nicolas Magand
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Nathalie Grand
- Department of Anesthesiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Stéphanie Leroy
- Department of Anesthesiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Thomas Corsini
- Department of Gynecology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Kasra Azarnoush
- Department of Cardiac Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Sylvain Grange
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
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Clermidy H, Fabre D, Hugues JN, Alonso CG, Mitilian D, Mercier O, Brenot P, Charbonneau P, Fadel E. Management of etonogestrel implant migration into the pulmonary artery. Contraception 2022; 113:62-67. [PMID: 35351447 DOI: 10.1016/j.contraception.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the relationship between time since contraceptive implant placement and retrieval outcomes in patients with implant migration into the pulmonary artery. STUDY DESIGN We reviewed all cases of pulmonary artery implant migration referred to the Marie Lannelongue hospital from 2015 through 2020. Using our hospital database, we collected patients' clinical data and removal information to assess the success of therapeutic management according to the delay between implant insertion and removal. RESULTS We identified eight cases. Physicians located two in the upper and six in the lower lobe. Five patients had associated pulmonary symptoms, most commonly, chest pain and dyspnea. Physicians attempted an endovascular procedure in all cases with successful removal in three patients. In the five failures, angiography displayed arterial thrombosis distal to the implant. These patients had successful removal with an open mini-thoracotomy (<5 cm). None of the eight patients had serious post-operative complications. For the three patients with successful endovascular retrieval, two had early diagnosis (≤ 3 months). CONCLUSION Endovascular approach with angiography should be performed as a first line treatment modality. Endothelialization and fibrosis within the vessel represent the principal limitations of endovascular strategy, but a retrieval could be attempted anyway with caution. In case of failure, an open approach is required. IMPLICATIONS STATEMENT When a migration into the pulmonary artery is diagnosed, health care professionals should refer patients as soon as possible to a tertiary center with a vascular surgery/interventional radiology and thoracic surgery departments.
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Affiliation(s)
- Hugo Clermidy
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Groupe Hospitalier Paris Saint-Joseph, Paris Saclay University, Le Plessis Robinson, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Groupe Hospitalier Paris Saint-Joseph, Paris Saclay University, Le Plessis Robinson, France..
| | - Jean Noel Hugues
- Unit of Reproductive Medicine, Department of Obstetrics-Gynaecology, Hopital Jean Verdier, Assistance Publique des Hôpitaux de Paris (AP-HP), Brondy, France
| | - Carlos Garcia Alonso
- Department of Interventional Radiology, Marie-Lannelongue Hospital, Groupe Hospitalier Paris Saint-Joseph, Paris Saclay University, Le Plessis Robinson, France
| | - Delphine Mitilian
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Groupe Hospitalier Paris Saint-Joseph, Paris Saclay University, Le Plessis Robinson, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Groupe Hospitalier Paris Saint-Joseph, Paris Saclay University, Le Plessis Robinson, France
| | - Philippe Brenot
- Department of Interventional Radiology, Marie-Lannelongue Hospital, Groupe Hospitalier Paris Saint-Joseph, Paris Saclay University, Le Plessis Robinson, France
| | - Philippe Charbonneau
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Groupe Hospitalier Paris Saint-Joseph, Paris Saclay University, Le Plessis Robinson, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Groupe Hospitalier Paris Saint-Joseph, Paris Saclay University, Le Plessis Robinson, France
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5
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Hellwinkel JE, Konigsberg MW, Oviedo J, Castaño PM, Kadiyala RK. Subfascial-located contraceptive devices requiring surgical removal. Contracept Reprod Med 2021; 6:13. [PMID: 33934717 PMCID: PMC8091535 DOI: 10.1186/s40834-021-00158-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background Subdermal etonogestrel implants are highly effective contraceptive methods. Despite standardization of insertion technique by the manufacturer, some implants are inadvertently placed too deeply within or below the plane of the biceps brachii fascia. Placement of these implants in a deep tissue plane results in more difficult removal, which is not always possible in the office setting. In rare cases, surgical removal by an upper extremity surgeon is warranted. Case presentation Here we present 6 cases of etonogestrel implants located in a subfascial plane requiring removal by an upper extremity surgeon. Implants were all localized with plain radiography and ultrasound prior to surgical removal. All cases had implants located in the subfascial plane and one was identified intramuscularly. The average age was 28 years (19–33) and BMI was 24.0 kg/m^2 (19.1–36.5), with the most common reason for removal being irregular bleeding. The majority of cases (5/6) were performed under monitored anesthesia care with local anesthetic and one case utilized regional anesthesia. All implants were surgically removed without complication. Conclusions Insertion of etonogestrel contraceptive implants deep to the biceps brachii fascia is a rare, but dangerous complication. Removal of these implants is not always successful in the office setting and referral to an upper extremity surgeon is necessary to avoid damage to delicate neurovascular structures for safe removal.
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Affiliation(s)
- Justin E Hellwinkel
- Department of Orthopedics, Columbia University Irving Medical Center, 622 W 168th St PH 11 - Center, NY, 10032, New York, USA.
| | - Matthew W Konigsberg
- Department of Orthopedics, Columbia University Irving Medical Center, 622 W 168th St PH 11 - Center, NY, 10032, New York, USA
| | - Johana Oviedo
- Department of Obstetrics and Gynecology, New York University Langone Health, 550 First Avenue, NY, 10016, New York, USA
| | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 W 168th St, NY, 10032, New York, USA
| | - R Kumar Kadiyala
- Department of Orthopedics, Columbia University Irving Medical Center, 622 W 168th St PH 11 - Center, NY, 10032, New York, USA
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6
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FSRH Guideline (February 2021) Progestogen-only Implant. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:1-62. [PMID: 33593815 DOI: 10.1136/bmjsrh-2021-chc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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7
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Simon C, Maurier A, Gaboriau L, Vrignaud L, Dayani P, Vaillant T, Andrée Bos-Thompson M, Jonville-Bera AP. Incidence and characteristics of intravascular pulmonary migration of etonogestrel implants: A French nationwide study. Contraception 2020; 102:186-189. [PMID: 32417204 DOI: 10.1016/j.contraception.2020.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 03/06/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE(S) To describe the features of etonogestrel implant (Nexplanon and Implanon) migration into the pulmonary vasculature and to estimate its incidence in France. STUDY DESIGN We retrospectively reviewed French cases of implant migration into the pulmonary vasculature reported up to 2018. Patient clinical data were collected. The annual incidence of migration was estimated from the number of cases reported and number of implants sold. RESULTS Twenty-seven cases of migration into the pulmonary vasculature were identified. In 19 cases (70%) it was stated that this was into the pulmonary artery (nine into the left branch, four into the right branch and six unspecified) and in the other eight cases (30%) it was it not specified whether this was into the pulmonary artery or one of its branches. The migration was discovered following a request for implant removal in 59% of cases, following respiratory complaints in 24%, and because the implant was no longer palpable in 17%. In the 24 cases for which information on removal (or not) was available, the implant was removed in 15 (60% by an endovascular procedure and 40% by invasive surgery); in the remainder it was left in situ. The incidence of migration into the pulmonary vasculature was 1.23 per 100,000 implants sold [95% CI 0.25-3.58] in 2014, increasing to 3.17 per 100,000 implants sold [1.37-6.24] in 2017. In 2016, the French National Agency for Medicines and Health Products Safety (ANSM) had recommended performing a systematic search for non-palpable implants, including at thorax level. CONCLUSIONS The incidence of migration into the pulmonary vasculature is low. Nonetheless, because the consequences are potentially serious, in December 2019 the ANSM made recommendations to reduce this risk.
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Affiliation(s)
- Corinne Simon
- Regional Pharmacovigilance Center, Department of Pharmacosurveillance, CHRU de Tours, 37044 Tours, France
| | - Ana Maurier
- Regional Pharmacovigilance Center, Department of Pharmacosurveillance, CHRU de Tours, 37044 Tours, France
| | - Louise Gaboriau
- Regional Pharmacovigilance Center, Department of Medical Pharmacology, CHRU de Lille, Lille, France
| | - Laura Vrignaud
- Regional Pharmacovigilance Center, Department of Pharmacosurveillance, CHRU de Tours, 37044 Tours, France
| | - Pauline Dayani
- French National Agency for Medicines and Health Products Safety (ANSM), 93285 Saint-Denis Cedex, France
| | - Tiphaine Vaillant
- French National Agency for Medicines and Health Products Safety (ANSM), 93285 Saint-Denis Cedex, France
| | - Marie Andrée Bos-Thompson
- Regional Pharmacovigilance Center, Department of Medical Pharmacology and Toxicology, CHRU de Montpellier, Montpellier, France
| | - Annie-Pierre Jonville-Bera
- Regional Pharmacovigilance Center, Department of Pharmacosurveillance, CHRU de Tours, 37044 Tours, France; Université de Tours, Université de Nantes, INSERM, SPHERE U1246 Tours, France.
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8
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Rael CT, Martinez M, Giguere R, Bockting W, MacCrate C, Mellman W, Valente P, Greene GJ, Sherman SG, Footer KHA, D'Aquila RT, Carballo-Diéguez A, Hope TJ. Transgender Women's Concerns and Preferences on Potential Future Long-Acting Biomedical HIV Prevention Strategies: The Case of Injections and Implanted Medication Delivery Devices (IMDDs). AIDS Behav 2020; 24:1452-1462. [PMID: 31654172 PMCID: PMC7181384 DOI: 10.1007/s10461-019-02703-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There are several long-acting biomedical HIV prevention products in the development pipeline, including injections and implanted medication delivery devices (IMDDs). It is critical to understand concerns and preferences on the use of these products in populations that shoulder a disproportionate burden of the HIV epidemic, such as transgender women. This will allow researchers and public health professionals to construct interventions tailored to the needs of these women to promote optimal use of these tools. In studies of other biomedical HIV prevention products (e.g., oral PrEP) it is clear that transgender women have unique concerns related to the use of these strategies. This may have an impact on this group's uptake and sustained use of longacting HIV prevention products. This study conducted four focus groups with N = 18 transgender women in New York City to understand their concerns and preferences on long-acting PrEP injections and IMDDs. Findings showed that participants were overwhelmingly positive about long-acting HIV prevention strategies, though they had some apprehensions. Overall, participants felt that injections and IMDDs could help address adherence challenges, and that transgender-specific needs should be addressed during clinical trials. Also, there were concerns related to injection or IMDD logistics, concerns about injections' or IMDDs' presence in the body, and familiarity with these products affected participants' opinions on them. Findings from this work can be used to inform protocols, measures, materials, and adherence interventions in future initiatives for transgender women using PrEP injections or IMDDs.
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Affiliation(s)
- Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., New York, NY, 10032, USA.
| | - Michelle Martinez
- Program for the Study of LGBT Health at the New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing, New York, NY, USA
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Walter Bockting
- Program for the Study of LGBT Health at the New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing, New York, NY, USA
| | - Caitlin MacCrate
- Program for the Study of LGBT Health at the New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing, New York, NY, USA
- CUNY School of Public Health, New York, NY, USA
| | - Will Mellman
- Program for the Study of LGBT Health at the New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing, New York, NY, USA
| | - Pablo Valente
- Program for the Study of LGBT Health at the New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing, New York, NY, USA
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - George J Greene
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susan G Sherman
- Department of Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine H A Footer
- Department of Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Richard T D'Aquila
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Thomas J Hope
- Northwestern University Feinberg School of Medicine, and Biomedical Engineering in the McCormick School of Engineering and Applied Sciences, Chicago, IL, USA
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9
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Abstract
OBJECTIVE To describe our experience with office removal of nonpalpable contraceptive implants at our referral center. METHODS We performed a retrospective cohort study by reviewing the charts of patients referred to our family planning specialty center for nonpalpable or complex contraceptive implant removal from January 2015 through December 2018. We localized nonpalpable implants using high-frequency ultrasonography and skin mapping in radiology, followed by attempted removal in the office using local anesthesia and a modified vasectomy clamp. We abstracted information on demographics, implant location, and outcomes. RESULTS Of 61 referrals, 55 patients attended their scheduled appointments. Seven patients had palpable implants; six elected removal. The other 48 patients had ultrasound localization, which identified 47 (98%) of the implants; the remaining patient had successful localization with computed tomography imaging. Nonpalpable implants were suprafascial (n=22), subfascial (n=25) and intrafascial (n=1); four of these patients opted to delay removal. Of 50 attempted office removals, all palpable (n=6), all nonpalpable suprafascial (n=21 [100%, 95% CI 83-100%]), and 19 out of 23 (83%, 95% CI 67-98%) subfascial implants were successful. Three of the four patients with failed subfascial implant office removal had successful operating room removal with a collaborative orthopedic surgeon; the other patient sought removal elsewhere. Transient postprocedure neuropathic complaints were noted in 7 out of 23 (30%, 95% CI 12-49%) subfascial and 1 out of 21 (5%, 95% CI 0-13%) suprafascial removals (P=.048). Nonpalpable implants were more likely to be subfascial in nonobese patients (24/34, 71%) as compared with obese (1/13, 8%) patients (P<.001). Seven (28%) of the 25 subfascially located implants had been inserted during a removal-reinsertion procedure through the same incision. CONCLUSION Most nonpalpable contraceptive implants can be removed in the office by an experienced subspecialty health care provider after ultrasound localization. Some patients may experience transient postprocedure neuropathic pain. Nonpalpable implants in thinner women are more likely to be in a subfascial location.
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10
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Ohannessian A, Levy A, Jaillant N, Tanguy Le Gac Y, D'Journo X, Vidal V, Agostini A. A French survey of contraceptive implant migration to the pulmonary artery. Contraception 2019; 100:255-257. [PMID: 31194964 DOI: 10.1016/j.contraception.2019.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE(S) To quantify implant migration to the pulmonary artery in France since 2012 and to describe the diagnoses and treatments. STUDY DESIGN We surveyed 780 physicians of the French national implant-referral network, the French Society of Chest and Cardiovascular Surgery, and the French Radiology Society about diagnosis of implant migration to the pulmonary artery vasculature. We evaluated total implant insertions in France using data from the Medic'AM database. RESULTS We identified 12 cases from 2012 to 2017. Ten of the cases were asymptomatic. Five devices were removed via interventional radiology, five surgically, and two were left in place. The number of insertions in France during the same years was approximately 1,200,000. CONCLUSION(S) Pulmonary artery migration following contraceptive implant insertion is rare with a migration incidence of 1 in 100,000. Most cases were diagnosed incidentally.
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Affiliation(s)
| | | | - Noémie Jaillant
- Service de chirurgie vasculaire, Hôpital le Bocage CHRU de Dijon, France
| | - Yan Tanguy Le Gac
- Pôle de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, France
| | - Xavier D'Journo
- Service de chirurgie thoracique, Chemin des Bourrely, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, France
| | - Vincent Vidal
- Department of Medical Imaging, Assistance Publique Hôpitaux de Marseille, La Timone Hospital, Aix Marseille University, France
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, La Conception Hospital, Marseille, France.
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11
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Wilcox KK, Turcer F, Soltes GD, Shin DS. Endovascular retrieval of contraceptive implant embolized to pulmonary artery. Radiol Case Rep 2018; 13:1285-1288. [PMID: 30275923 PMCID: PMC6161411 DOI: 10.1016/j.radcr.2018.08.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022] Open
Abstract
Embolization of subdermally implanted contraceptive devices is a rare but potentially serious event. Timely removal of the embolized foreign body should be considered to prevent possible hemodynamic, respiratory, or hormonal complications. We present a case of a 22-year-old woman with a contraceptive implant embolized to her right lower lobar pulmonary artery, which was successfully managed by endovascular retrieval.
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Affiliation(s)
- Kyle K Wilcox
- Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195, USA
| | - Filip Turcer
- Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195, USA
| | - George D Soltes
- Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195, USA
| | - David S Shin
- Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195, USA
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12
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Zhang S, Batur P, Martin C, Rochon PJ. Contraceptive Implant Removals with the Use of IR. J Vasc Interv Radiol 2018; 29:1317-1319. [PMID: 30146212 DOI: 10.1016/j.jvir.2018.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Salina Zhang
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pelin Batur
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Primary Care Women's Health, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles Martin
- Division of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul J Rochon
- Division of Interventional Radiology, University of Colorado, 12401 E 17th Avenue, Mailstop L954, Aurora, Colorado 80045
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13
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Akhtar MM, Bhan A, Lim ZY, Akhtar MA, Sekhri N, Bharadwaj P, Mullen M. Percutaneous extraction of an embolized progesterone contraceptive implant from the pulmonary artery. Open Access J Contracept 2018; 9:57-61. [PMID: 30140161 PMCID: PMC6054767 DOI: 10.2147/oajc.s165827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Nexplanon® implant is a commonly used radiopaque contraceptive device that contains progestogen associated with an ethylene vinyl-acetate copolymer resulting in a slow release of the active hormonal ingredient. It is inserted into the subdermal connective tissue and provides contraceptive efficacy for up to 3 years. Device removal for clinical, personal or device “end-of-life span” reasons is straightforward. In rare cases, implant migration can occur locally within centimeters of the insertion site. Distant device embolization is extremely rare and can result in complications including chest pain, dyspnoea, pneumothorax and thrombosis or prevent conception until the active ingredient is depleted. We present one such case, where a Nexplanon® implant embolized into the pulmonary artery of a young female patient. We describe the initial “missed” diagnosis of embolized device on a chest radiograph and subsequent successful percutaneous removal once distant embolization was diagnosed.
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Affiliation(s)
- Mohammed Majid Akhtar
- Institute of Cardiovascular Sciences, University College London, London, UK, .,Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK,
| | - Amit Bhan
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK,
| | - Zhan Yun Lim
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK,
| | - Mohammed Abid Akhtar
- Department of Cardiology and Cardiac Transplantation, Harefield Hospital, Royal Brompton & Harefield NHS Trust, London, UK
| | - Neha Sekhri
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK,
| | - Preeti Bharadwaj
- Community Gynaecology and Sexual & Reproductive Health Department, Waltham Forest, North East London Foundation Trust, London, UK
| | - Michael Mullen
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK,
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14
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Zhang S, Batur P, Martin C, Rochon PJ. Contraceptive Implant Migration and Removal by Interventional Radiology. Semin Intervent Radiol 2018; 35:23-28. [PMID: 29628612 DOI: 10.1055/s-0038-1636517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
As the reversible contraceptive arm implants grow more popular, there is an increasing need to recognize the complications resulting from implant migration and removal. This review summarizes the findings of imaging and removal methods. When an implant is lost, the axillary region should be investigated first. If the implant still cannot be found, visualization though different methods have been employed for non-radiopaque implants. Real-time fluoroscopic-guided localization and removal can be accomplished for radiopaque Nexplanon. Once the implant has been located, standard removal method and other modified techniques can be used to safely remove the implant depending on the implant's location.
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Affiliation(s)
- Salina Zhang
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pelin Batur
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Primary Care, Women's Health, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles Martin
- Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul J Rochon
- Department of Interventional Radiology, University of Colorado, Denver, Colorado
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15
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Scher D, Broderick S, Holly B. Retrieval of an Essure Device from the Pulmonary Arterial System. J Vasc Interv Radiol 2017; 28:1297-1299. [PMID: 28841942 DOI: 10.1016/j.jvir.2017.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Daniel Scher
- Department of Vascular and Interventional Radiology, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287
| | - Stephen Broderick
- Department of Vascular and Interventional Radiology, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287
| | - Brian Holly
- Department of Vascular and Interventional Radiology, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287
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