Semin intervent Radiol 2018; 35(01): 023-028
DOI: 10.1055/s-0038-1636517
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Contraceptive Implant Migration and Removal by Interventional Radiology

Salina Zhang
1   Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Pelin Batur
1   Case Western Reserve University School of Medicine, Cleveland, Ohio
2   Department of Primary Care, Women's Health, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
,
Charles Martin III
3   Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
,
Paul J. Rochon
4   Department of Interventional Radiology, University of Colorado, Denver, Colorado
› Author Affiliations
Further Information

Publication History

Publication Date:
05 April 2018 (online)

Abstract

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.

 
  • References

  • 1 Pattman R, Sankar N, Elawad B, Handy P, Price DA. Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health. 2nd. Vol. Canada: Oxford University Press; 2010
  • 2 Preterm Birth | Maternal and Infant Health | Reproductive Health | CDC. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. Available at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm . Published 2016. Accessed March 27, 2017
  • 3 American College of Obstetricians and Gynecologists. Increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy. Committee Opinion No. 642. Obstet Gynecol 2015; 126: 44-48
  • 4 Nouri K, Pinker-Domenig K, Ott J, Fraser I, Egarter C. Removal of non-palpable Implanon® with the aid of a hook-wire marker. Contraception 2013; 88 (04) 577-580
  • 5 Curtis KM, Tepper NK, Jatlaoui TC. , et al. U.S. medical eligibility criteria for contraceptive use. MMWR Recomm Rep 2016; 65 (03) 1-104
  • 6 Praptohardjo R, Praptohardjo U. ‘U’ technique and standard technique of Norplant removal. Adv Contracept 1995; 11 (02) 115-122
  • 7 Darney PD. Hormonal implants: contraception for a new century. Am J Obstet Gynecol 1994; 170 (5, Pt 2): 1536-1543
  • 8 Food and Drug Administration. Nexplanon (etonogestrel implant). FDA approval letter; Department of Health and Human Services. Dep Heal Hum Serv 2011; 1–5 DOI: 10.1016/j.jacc.2014.08.021.2.
  • 9 Levine JP, Sinofsky FE, Christ MF. ; Implanon US Study Group. Assessment of Implanon insertion and removal. Contraception 2008; 78 (05) 409-417
  • 10 Creinin MD, Kaunitz AM, Darney PD. , et al. The US etonogestrel implant mandatory clinical training and active monitoring programs: 6-year experience. Contraception 2017; 95 (02) 205-210
  • 11 Sarma SP, Hatcher RP. Neurovascular injury during removal of levonorgestrel implants. Am J Obstet Gynecol 1995; 172 (1, Pt 1): 120-121
  • 12 Sarma SP, Silverstein M, Lewis C. Removal of a Norplant implant located near a major nerve using interventional radiology-digital subtraction fluoroscopy. Contraception 1998; 58 (06) 387-389
  • 13 Smith JM, Conwit RA, Blumenthal PD. Ulnar nerve injury associated with removal of Norplant implants. Contraception 1998; 57 (02) 99-101
  • 14 Nash C, Staunton T. Focal brachial cutaneous neuropathy associated with Norplant use: suggests careful consideration of the recommended site for inserting contraceptive implants. J Fam Plann Reprod Health Care 2001; 27 (03) 155-156
  • 15 Adkinson JM, Talsania JS. Ulnar nerve ligation after removal of Norplant: a case report. Hand (NY) 2013; 8 (01) 92-96
  • 16 Diego D, Tappy E, Carugno J. Axillary migration of Nexplanon®: Case report. Contraception 2017; 95 (02) 218-220
  • 17 Uwagbai ON, Wittich AC. Migration of a subcutaneous contraceptive device. J Am Osteopath Assoc 2016; 116 (09) 627
  • 18 Evans R, Holman R, Lindsay E. Migration of Implanon: two case reports. J Fam Plann Reprod Health Care 2005; 31 (01) 71-72
  • 19 Stillwell S, Sheppard P, Searle S. ; S SSSPS. The impalpable Implanon: a case report. J Fam Plann Reprod Health Care 2003; 29 (03) 156-157
  • 20 Twickler DM, Schwarz BE. Imaging of the levonorgestrel implantable contraceptive device. Am J Obstet Gynecol 1992; 167 (02) 572-573
  • 21 Kirk EP, Field CS. Difficult Norplant removal facilitated by fluoroscopy. Am J Obstet Gynecol 1993; 169 (03) 748
  • 22 Thurmond AS, Weinstein AS, Jones MK, Jensen JT, Nichols MD. Localization of contraceptive implant capsules for removal. Radiology 1994; 193 (02) 580-581
  • 23 Berg WA, Hamper UM. Norplant implants: sonographic identification and localization for removal. AJR Am J Roentgenol 1995; 164 (02) 419-420
  • 24 Cecil H, Reed D, Holtz J. Norplant removal facilitated by use of ultrasound for localization. J Fam Pract 1995; 40 (02) 182-183
  • 25 Glauser SJ, Scharling ES, Stovall TG, Zagoria RJ. Ultrasonography: usefulness in localization of the Norplant contraceptive implant system. J Ultrasound Med 1995; 14 (06) 411-414
  • 26 Letterie GS, Garnaas M. Localization of “lost” Norplant capsules using compression film screen mammography. Obstet Gynecol 1995; 85 (5, Pt 2, Suppl): 886-887
  • 27 Thomsen RJ, Pasquale S, Nosher J. Ultrasonic visualization of NORPLANT subdermal contraceptive devices. Int J Gynaecol Obstet 1985; 23 (03) 223-227
  • 28 Lang JF, Heine MW, Purdon TF. Use of needle localization for difficult Norplant removal. Am J Obstet Gynecol 1994; 171 (04) 1161-1162
  • 29 Rodriguez H, King B, Otis AM. Localization of concealed Norplant implants and implant fragments by a modified mammography technique. J Pediatr Adolesc Gynecol 2000; 13 (04) 163-166
  • 30 Kang W, Hian Tan K. A simple technique for localization of deeply inserted, nonpalpable Norplant implant. Contraception 2005; 71 (05) 392-394
  • 31 Lantz A, Nosher JL, Pasquale S, Siegel RL. Ultrasound characteristics of subdermally implanted Implanon contraceptive rods. Contraception 1997; 56 (05) 323-327
  • 32 James P, Trenery J. Ultrasound localisation and removal of non-palpable Implanon implants. Aust N Z J Obstet Gynaecol 2006; 46 (03) 225-228
  • 33 Singh M, Mansour D, Richardson D. Location and removal of non-palpable Implanon implants with the aid of ultrasound guidance. J Fam Plann Reprod Health Care 2006; 32 (03) 153-156
  • 34 Merki-Feld GS, Brekenfeld C, Migge B, Keller PJ. Nonpalpable ultrasonographically not detectable Implanon rods can be localized by magnetic resonance imaging. Contraception 2001; 63 (06) 325-328
  • 35 Shulman LP, Gabriel H. Management and localization strategies for the nonpalpable Implanon rod. Contraception 2006; 73 (04) 325-330
  • 36 Vollans SR, Grainger A, O'Connor P, Limb D. Hormone-releasing contraceptive implants: our experience of complex removals using preoperative ultrasound. Contraception 2015; 92 (01) 81-83
  • 37 Patel A, Shetty D, Hollings N, Dodds N. Contraceptive implant embolism into the pulmonary artery. Ann Thorac Surg 2014; 97 (04) 1452
  • 38 D'Journo XB, Vidal V, Agostini A. Intravascular pulmonary migration of a subdermal contraceptive implant. Ann Thorac Surg 2015; 99 (05) 1828
  • 39 Heudes PM, Laigle Querat V, Darnis E, Defrance C, Douane F, Frampas E. Migration of a contraceptive subcutaneous device into the pulmonary artery. Report of a case. Case Rep Women's Heal 2015; 8: 6-8
  • 40 O' Brien A, O'Reilly MK, Sugrue G, Lawler L, Farrelly C. Subdermal contraceptive implant embolism to a pulmonary artery. Ann Thorac Surg 2015; 99 (06) 2254-2255
  • 41 Maroteix P, Dupeyrat J, Roupie E. Embolie pulmonaire par implant progestatif. Ann Françaises Médecine D'urgence 2015; 5 (06) 332-333
  • 42 Barlow-Evans R, Jaffer K, Balogun M. Migration of a Nexplanon contraceptive implant to the pulmonary artery. BMJ Case Rep 2017; 2017: bcr-2017-bcr-219259
  • 43 Gallon A, Fontarensky M, Chauffour C, Boyer L, Chabrot P. Looking for a lost subdermal contraceptive implant? Think about the pulmonary artery. Contraception 2017; 95 (02) 215-217
  • 44 Thomas PA, Di Stefano D, Couteau C, D'Journo XB. Contraceptive implant embolism into the pulmonary artery: thoracoscopic retrieval. Ann Thorac Surg 2017; 103 (03) e271-e272
  • 45 Choi JH, Kim HY, Lee SS, Cho S. Migration of a contraceptive subdermal device into the lung. Obstet Gynecol Sci 2017; 60 (03) 314-317
  • 46 Rowlands S, Mansour D, Walling M. Intravascular migration of contraceptive implants: two more cases. Contraception 2017; 95 (02) 211-214
  • 47 Wehrle KE. The Norplant system: easy to insert, easy to remove. Nurse Pract 1994; 19 (04) 47-54
  • 48 Inserting and removing levonorgestrel subdermal implants: an update. Contracept Rep 1994; 5 (05) 4-12
  • 49 Chen MJ, Creinin MD. Removal of a nonpalpable Etonogestrel implant with preprocedure ultrasonography and modified vasectomy clamp. Obstet Gynecol 2015; 126 (05) 935-938
  • 50 Vidin E, Garbin O, Rodriguez B, Favre R, Bettahar-Lebugle K. Removal of etonogestrel contraceptive implants in the operating theater: report on 28 cases. Contraception 2007; 76 (01) 35-39
  • 51 Guiahi M, Tocce K, Teal S, Green T, Rochon P. Removal of a Nexplanon implant located in the biceps muscle using a combination of ultrasound and fluoroscopy guidance. Contraception 2014; 90 (06) 606-608
  • 52 Chung M, Loudill C, Wieler M, Farnam J, Ahn SH. Endovascular retrieval of Nexplanon from the distal pulmonary artery. J Vasc Interv Radiol 2017; 28 (03) 466-467
  • 53 Wechselberger G, Wolfram D, Pülzl P, Soelder E, Schoeller T. Nerve injury caused by removal of an implantable hormonal contraceptive. Am J Obstet Gynecol 2006; 195 (01) 323-326
  • 54 Brown M, Britton J. Neuropathy associated with etonogestrel implant insertion. Contraception 2012; 86 (05) 591-593
  • 55 Pymar HC, Creinin MD, Schwartz JL. “Pop-out” method of levonorgestrel implant removal. Contraception 1999; 59 (06) 383-387