Percutaneous extraction of an embolized progesterone contraceptive implant from the pulmonary artery

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.

Migración de implante anticonceptivo subdérmico a rama segmentaria de la arteria pulmonar

“…El implante anticonceptivo subdérmico de varilla única contiene un progestágeno sintético que proporciona un efecto anticonceptivo por hasta 3 años y tiene el beneficio adicional de ser radioopaco, al contener 15 mg de sulfato de bario, lo que permite su visualización con los métodos de imágenes 1,2 . Es una varilla de 4 cm de longitud y 2 mm de diámetro que se coloca entre 8 y 10 cm por encima del codo, en la cara medial del brazo no dominante [3][4][5][6][7] .…”

“…En las adolescentes puede generar aumento de peso, acné y cefaleas 3,6,8 . La migración es una complicación poco frecuente, ya sea a sitios cercanos a la inserción o a sitios distantes, incluyendo ramas de la arteria pulmonar 1,2,[5][6][7] .…”

FSRH Guideline (February 2021) Progestogen-only Implant

“…International case reports142–158 describe intravascular migration of 17 ENG-IMP (both Implanon and Nexplanon) to the pulmonary vasculature after presumed insertion into veins in the upper arm. Kang et al 140 reported nine and Ohannessian et al 141 reported seven additional cases of implant migration to the pulmonary vasculature.…”

“…If, after appropriate imaging, the ENG-IMP is not identified in the arm, further investigation by specialist services may include serum ENG assay and imaging of the chest – chest X-ray/CT/CT pulmonary angiography according to local protocol 142–157. Case studies report both percutaneous and endovascular retrieval of implants from the pulmonary vasculature as well as implants left in situ 142–157…”

Implanon NXT embolisation into the pulmonary arterial tree

“…6 Endovascular embolisation of an Implanon NXT device remains a very rare complication in current literature and is limited to case reports. [7][8][9]…”