Intravascular migration of contraceptive implants: two more cases

Abstract

30Cases: In addition to previously published case reports, further cases of intravascular migration of 31 contraceptive implants have been identified from an information request to two national adverse 32 reaction spontaneous reporting systems. We report on two new cases of insertion into the venous 33 system with subsequent embolism to a pulmonary artery. Conclusion: Incorporating barium sulfate 34 into the implant has facilitated diagnosis of these very rare adverse events with the initial diagnosis 35 of embolism to the pulmonary arterial tree made by chest X-ray. Removal of an implant from a 36 segmental branch of a pulmonary artery is technically challenging and not without risks. 37Unsuccessful removal appears to be preceded by a delay in diagnosis leading to endothelialisation of 38 the implant in the pulmonary arterial wall. Implications: Subdermal placement of contraceptive 39 implants over the anterior surface of the biceps rather than in the sulcus between the biceps and 40 triceps may negate this rare but reported risk.

Referral Center Experience With Nonpalpable Contraceptive Implant Removals

“…I nstructions for contraceptive subdermal implant insertion have changed over the past decade, primarily inspired by complications related to deep insertions, including intravascular placement and pulmonary artery migration. [1][2][3][4] The most recent recommendation for optimal placement is between the dermis and the subcutaneous tissue in the area of the arm over the triceps muscle, with the intent to minimize neurovascular injury should deep insertion inadvertently occur.…”

Contraceptive Implant Migration and Removal by Interventional Radiology

“…Typically, the implant then travels from the basilic vein and embolizes to the pulmonary arteries. 46 A chest X-ray should be considered early to avoid delays in diagnosis; if endothelialization of the implant occurs, removal may require surgery (or cause infertility and menstrual irregularities if not removed).…”

Peripheral Nerve Injury Associated with a Subdermal Contraceptive Implant: Illustrative Cases and Systematic Review of Literature

“…The cohort consisted of 12 patients with a mean age of 29.8 years (range, 19e44 years) who were evaluated at a mean follow-up of 0.7 year (range, 0e2 years); 1 patient was lost to follow-up. 8 Norplanon (n ¼ 4), Implanon (n ¼ 4), and Nexplanon (n ¼ 4) SCIs were implanted in the nondominant arm ( performed to treat neuroma or nerve compression by scar tissues and/or SCis. Of patients, 5 completely recovered, and 6 continued to have a motor and/or sensory deficit at short-term to Jong-term followup; 1 patient was Jost to follow-up.'…”

“…7 The manufacturer of Nexplanon implants estimates that intravascular placement has occurred in just over 1 patient per 1 million Nexplanon implants sold. 8 However, given the recommended site of implantation, neurovascular injuries remain a potential complication for both SCI insertion and removal. 9 In this article, we present a systematic review of the literature on nerve injuries associated with SCIs.…”