Subdermal Contraceptive Implant Embolism to a Pulmonary Artery

Brien, Amy O’; O’Reilly, Martin; Sugrue, Gavin; Lawler, Leo P.; Farrelly, Cormac

doi:10.1016/j.athoracsur.2014.12.017

Cited by 22 publications

(28 citation statements)

References 2 publications

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“…The Sponsor encountered infrequent (0.26%) events reporting of migration in the AMP. Although rare cases of migration to the pulmonary artery have been described [10][11][12][13][14][15], the AMP participants did not report such cases.…”

Section: Discussionmentioning

confidence: 79%

The US etonogestrel implant mandatory clinical training and active monitoring programs: 6-year experience

et al. 2017

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Objective: The objective was to monitor the effectiveness of the etonogestrel implant clinical training program through a voluntary active monitoring program (AMP). Study design: US health care providers underwent mandatory training by the manufacturer on etonogestrel implant insertion, localization and removal. After training, health care providers could enroll in a voluntary AMP to provide outcome data to meet a postmarketing commitment of the manufacturer with the US Food and Drug Administration (FDA). Those who volunteered completed and faxed forms to the manufacturer after implant insertion and removal detailing the procedure and device-related outcomes, including insertion-, localizationor removal-associated events. Experts reviewed outcome data quarterly, which the Sponsor then reported to the FDA. Results: Among 42,337 health care providers completing the training program, 4294 (10.1%) volunteered to participate in the AMP. The 26,198 forms submitted over 6.4 years included more insertion (n=20,497) forms than removal forms (n=5701). The volunteers reported 646 events on 566 (2.2%) forms related to insertion (n=197), localization (n=34), removal (n=357) and "other" (n=58). Clinically important events included noninsertion (n=4), serum etonogestrel positive but implant not found (n=1), and possible nerve (n=66) or vascular (n=5) injury. The reports did not include any insertion-, localization-or removal-associated hospitalizations. Eight (0.14%) removal reports described referral for surgical implant removal. Conclusion: Events related to insertion, localization or removal of the etonogestrel implant are uncommon among US providers who received mandatory training in the use of the implant. Implications: This report presents results from the first mandatory US contraceptive training program. Health care providers volunteered to report information about etonogestrel implant insertion, localization and removal. Although the data do not demonstrate whether a mandatory program improves outcomes, they elucidate the utility and real-life experience that clinical training programs can provide.

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Section: Discussionmentioning

confidence: 79%

The US etonogestrel implant mandatory clinical training and active monitoring programs: 6-year experience

et al. 2017

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“…Searched literature demonstrated nine publications of pulmonary artery migration. [37][38][39][40][41][42][43][44][45] Most cases of significant migration result from the implant being inadvertently inserted into the venous system. Typically, the implant then travels from the basilic vein and embolizes to the pulmonary arteries.…”

Section: Discussion Visualization Techniquesmentioning

confidence: 99%

Contraceptive Implant Migration and Removal by Interventional Radiology

Zhang

Batur

Martin

et al. 2018

Semin intervent Radiol

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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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“…This is very rare with five cases published over the last two years (Cases 1 -5, Table 1). These five case reports from three adjacent countries in Western Europe [6][7][8][9][10] have been written by radiologists, thoracic surgeons and emergency medicine specialists. All five reports relate to the radiopaque version of the etonogestrel implant.…”

Section: Discussionmentioning

confidence: 99%

Intravascular migration of contraceptive implants: two more cases

Rowlands

Mansour²,

Walling³

2017

Contraception

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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.

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Subdermal Contraceptive Implant Embolism to a Pulmonary Artery

Cited by 22 publications

References 2 publications

The US etonogestrel implant mandatory clinical training and active monitoring programs: 6-year experience

The US etonogestrel implant mandatory clinical training and active monitoring programs: 6-year experience

Contraceptive Implant Migration and Removal by Interventional Radiology

Intravascular migration of contraceptive implants: two more cases

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