Migration of implanon contraceptive implant into the pulmonary artery

Cerato, Andrea; Luyckx, Mathieu; Ghaye, Benoît

doi:10.1016/j.diii.2018.08.006

Cited by 10 publications

(6 citation statements)

References 2 publications

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“…year Authors Title Age Migration site Operative results Case notes 2018 Gao, G. T. Embolization of a contraceptive implant into the pulmonary vasculature in an adolescent female [ 15 ] 16 LLL SRWC via EI Pt presented to peds ER with subjective dyspnea 2018 Wilcox, K. K. Endovascular retrieval of contraceptive implant embolized to pulmonary artery a 22 RLL SRWC via EI – 2018 Akhtar, M. M. Percutaneous extraction of an embolized progesterone contraceptive implant from the pulmonary artery a 31 RLL SRWC via EI Pt sought elective removal 1 year after implantation without complaints 2019 Carlos-Alves, M. Lung migration of contraceptive Implanon NXT a 31 LLL SRWC via VATS – 2019 Cerato, A. Migration of contraceptive implant into the pulmonary artery [ 13 ] 16 Latero-basal LLL EI not attempted (complete vascular retraction around the device). Pt declined further intervention – 2020 Simon, C. Incidence and characteristics of intravascular pulmonary migration of etonogestrel implants: a French nationwide study [ 12 ] various (27) LPA (9), RPA (4), unspecified (14) SRWC via EI (10), SRWC via surgery (5), left in situ (9), unspecified (3) – 2020 …”

Section: Discussionmentioning

confidence: 99%

“…A minimally invasive approach, such as endovascular retrieval should then be considered if the patient strongly desires implant removal, or if the patient is symptomatic because of the embolized device. Endovascular approaches have the benefit of sparing lung tissue and avoiding the pain of chest-wall incisions, but can be complicated by the Nexplanon’s tendency to encapsulate and adhere to adjacent tissue [ 1 – 3 , 6 , 12 , 13 ]. This encapsulation is by design and is meant to prevent a Nexplanon from leaving its primary placement site, but can be problematic if it occurs after the device has moved.…”

Section: Discussionmentioning

confidence: 99%

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Nexplanonectomy—the surgical removal of an embolized implanted contraceptive device: a case report and review of the literature

Maybury,

Affrin,

Popa

et al. 2024

J Med Case Reports

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Background Nexplanon implants are a common hormonal contraceptive modality. Though rare, these devices can embolize into the injured wall of the basilic vein, through the right heart, and finally wedge itself into a pulmonary artery. With adherence to the arterial wall over time, it becomes less amenable to endovascular retrieval. Patients may present with symptoms mimicking a pulmonary embolism, or without any symptoms at all. In asymptomatic cases, endovascular retrieval and/or surgery is required when patients wish to begin having children prior to biological inactivity. The current literature showed as little as nine case reports detailing lung tissue removal in the aim of reversing a patient’s implanted contraceptive device. Case presentation A 22-year-old asymptomatic active-duty Caucasian female presented for elective outpatient Nexplanon removal. The suspicion of possible implant migration arose when it was discovered to be non-palpable in her left arm. After plain film x-rays failed to localize the implant, a chest x-ray and follow-up Computed Tomography (CT) scan revealed that the Nexplanon had migrated to a distal branch of the left pulmonary artery. Due to the patient’s strong desires to begin having children, the decision was made for removal. Initial endovascular retrieval failed due to Nexplanon encapsulation within the arterial wall. Ultimately, the patient underwent a left video-assisted thoracoscopic surgery (VATS) for exploration and left lower lobe basilar S7–9 segmentectomy, which successfully removed the Nexplanon. Conclusions Implanted contraceptive devices can rarely result in migration to the pulmonary vasculature. These radiopaque devices are detectable on imaging studies if patients and clinicians are unable to palpate them. An endovascular approach should be considered first to spare lung tissue and avoid chest-wall incisions, but can be complicated by encapsulation and adherence to adjacent tissue. A VATS procedure with single-lung ventilation via a double-lumen endotracheal tube allows surgeons to safely operate on an immobilized lung while anesthesiologists facilitate single-lung ventilation. This patient’s case details the uncommon phenomenon of Nexplanon migration, and the exceedingly rare treatment resolution of lung resection to remove an embolized device.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nexplanonectomy—the surgical removal of an embolized implanted contraceptive device: a case report and review of the literature

Maybury,

Affrin,

Popa

et al. 2024

J Med Case Reports

View full text Add to dashboard Cite

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“…The first medical decision involves deciding between removal [ 5 , 6 ] or 'watching-and-waiting' [ 7 , 8 ]. The decision for removal should be discussed with the patient due to the asymptomatic nature of device migration.…”

Section: Discussionmentioning

confidence: 99%

“…The main arguments for the ‘watch-and-wait’ approach include peripheric location with patient’s refusal of surgery [ 8 ], a risk–benefit balance deemed unfavourable for both approaches [ 7 ], or the failure of the endovascular attempt and patient’s refusal of surgery [ 9 ]. Potential complications of pulmonary catheterization include possible perforation of the vessel wall, injury to the tricuspid valve, arrhythmias, artery spasm, thrombosis of the pulmonary artery, and hematoma at the puncture site [ 8 ]. The potential complication of removal is injury to a pulmonary arterial branch, with alveolar haemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Endovascular retrieval of a migrated contraceptive implant into the pulmonary artery : case report and review of literature

Grange,

Magand,

Grand

et al. 2024

CVIR Endovasc

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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. Graphical Abstract

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“…2 Prior case reports have described proximal migration of the device into the axilla, 5 in the deep compartments of the arm, and even into pulmonary vasculature. [6][7][8] Factors associated with difficult removals include weight gain and longer duration of device placement. 9 In addition, identifying anatomic landmarks of the upper extremity can be challenging in patients with obesity, 10 which may negatively impact insertion technique and palpation for removal.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Patients Requiring Surgical Removal of Subdermal Contraceptive Implants: A Case–Control Study

Katabi¹,

Stevens²,

Ascha³

et al. 2022

OAJC

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Etonogestrel subdermal implants are a commonly used contraceptive device placed in the medial upper arm. Plastic and orthopedic surgeons may be consulted for difficult implant removals. We performed a case-control study comparing patients undergoing surgical and uncomplicated in-office removal at our institution. Patients and Methods: We identified patients who underwent operative removal of implantable contraceptive devices by plastic or orthopedic surgeons at our institution from January 2014 to October 2019. Patients who underwent uncomplicated office removal during the same time were compared. Demographic and surgical variables were collected, and descriptive statistics were calculated. Univariate and multivariate logistic regression was performed with surgical versus outpatient removal as the outcome of interest. Results: A total of 669 patients undergoing etonogestrel subdermal implant removals were identified during the five-year study period, of which thirteen patients required surgical removal (1.9%) and 326 were selected as uncomplicated removal comparisons. There were no significant differences in median (IQR) body mass index (BMI) (31.1 [28.2, 35.2] versus 29.3 [24.0, 35.1], p = 0.19), median (IQR) weight gain since device placement (5 [−0.6, 14.7] kilograms versus 1.6 [−1.2, 5.8] kilograms, p = 0.15), or length of time since device insertion (2.3 [0.8, 2.8] years versus 1.0 [0.4, 2.2] years, p = 0.17). Of those who needed surgical removal, the most common indication for implant removal was device expiration (n = 5, 38.5%). Devices placed by OBGYN attendings were less likely to require surgical removal (p = 0.02). Family medicine attendings were more likely to refer patients for surgical removal (p = 0.02). No significant findings were detected on univariate or multivariate regression. Among surgical removals, radiography was the most frequently used imaging modality. Implants were most frequently subdermal (n = 11, 84.6%) though intramuscular placement was also identified (n = 2, 15.4%). Only one patient had residual paresthesia along the length of the incision. No other complications were identified. Conclusion:We did not identify risk factors associated with the difficult removal of etonogestrel subdermal implants. Practitioners should consult upper extremity surgeons if they encounter difficult removals.

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Migration of implanon contraceptive implant into the pulmonary artery

Cited by 10 publications

References 2 publications

Nexplanonectomy—the surgical removal of an embolized implanted contraceptive device: a case report and review of the literature

Nexplanonectomy—the surgical removal of an embolized implanted contraceptive device: a case report and review of the literature

Endovascular retrieval of a migrated contraceptive implant into the pulmonary artery : case report and review of literature

Characteristics of Patients Requiring Surgical Removal of Subdermal Contraceptive Implants: A Case–Control Study

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