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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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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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Shams TM, Alhashemi HH, Fallatah AA, Alkhalid AM, Alhazmi FM, Bin Yunus MK, Radey RN, Hamad AF, Beyari HT, Alharazi SS. Outcomes of etonogestrel subdermal contraceptive implants: A single center cross-sectional study. Saudi Med J 2024; 45:261-266. [PMID: 38438213 PMCID: PMC11115393 DOI: 10.15537/smj.2024.45.3.20230840] [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: 10/30/2023] [Accepted: 01/15/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES To examine the prevalence of menstrual irregularities, side effects, and discontinuation rates of etonogestrel subdermal implants (ESI) in women attending King Abdulaziz Medical City, Jeddah, Saudi Arabia. METHODS This cross-sectional was carried out based on electronic medical records and a phone-based questionnaire administered to women who underwent ESI insertion in a single tertiary care hospital in Jeddah, Saudi Arabia, between 2019 and 2022. The primary objective was the prevalence of menstrual abnormalities. The secondary study objective included the discontinuation rate, reasons for discontinuation, and ESI side effects. RESULTS In total, 345 women with ESI were included in this study. The prevalence of any type of menstrual abnormalities was 88%. Other side effects included skin and mood changes, arm pain, and numbness. The discontinuation rate was 11% in the first year and 22% before the completion of 36 months. CONCLUSION Although menstrual abnormalities are a common side effect of ESI, only 22% of users discontinued this method of contraception.
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Affiliation(s)
- Taghreed M. Shams
- From the Department of Obstetrics and Gynecology (Shams), College of Medicine, King Saud bin Abdulaziz University For Health Sciences;
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Hashem H. Alhashemi
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Albaraa A. Fallatah
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Asma M. Alkhalid
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Fai M. Alhazmi
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Mohammed K. Bin Yunus
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Rani N. Radey
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Asalah F. Hamad
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Hatoon T. Beyari
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Shahad S. Alharazi
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
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Fayzullin A, Bakulina A, Mikaelyan K, Shekhter A, Guller A. Implantable Drug Delivery Systems and Foreign Body Reaction: Traversing the Current Clinical Landscape. Bioengineering (Basel) 2021; 8:bioengineering8120205. [PMID: 34940358 PMCID: PMC8698517 DOI: 10.3390/bioengineering8120205] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023] Open
Abstract
Precise delivery of therapeutics to the target structures is essential for treatment efficiency and safety. Drug administration via conventional routes requires overcoming multiple transport barriers to achieve and maintain the local drug concentration and commonly results in unwanted off-target effects. Patients’ compliance with the treatment schedule remains another challenge. Implantable drug delivery systems (IDDSs) provide a way to solve these problems. IDDSs are bioengineering devices surgically placed inside the patient’s tissues to avoid first-pass metabolism and reduce the systemic toxicity of the drug by eluting the therapeutic payload in the vicinity of the target tissues. IDDSs present an impressive example of successful translation of the research and engineering findings to the patient’s bedside. It is envisaged that the IDDS technologies will grow exponentially in the coming years. However, to pave the way for this progress, it is essential to learn lessons from the past and present of IDDSs clinical applications. The efficiency and safety of the drug-eluting implants depend on the interactions between the device and the hosting tissues. In this review, we address this need and analyze the clinical landscape of the FDA-approved IDDSs applications in the context of the foreign body reaction, a key aspect of implant–tissue integration.
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Affiliation(s)
- Alexey Fayzullin
- Department of Experimental Morphology and Biobanking, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.F.); (A.B.); (K.M.); (A.S.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Alesia Bakulina
- Department of Experimental Morphology and Biobanking, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.F.); (A.B.); (K.M.); (A.S.)
| | - Karen Mikaelyan
- Department of Experimental Morphology and Biobanking, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.F.); (A.B.); (K.M.); (A.S.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Anatoly Shekhter
- Department of Experimental Morphology and Biobanking, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.F.); (A.B.); (K.M.); (A.S.)
| | - Anna Guller
- Department of Experimental Morphology and Biobanking, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.F.); (A.B.); (K.M.); (A.S.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Biomolecular Discovery Research Centre, Macquarie University, Sydney, NSW 2109, Australia
- Correspondence:
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