Removal of subdermal implantable contraceptive devices utilizing ultrasound and fluoroscopic guidance
Heilala A, Hillman D, and Albeer Y. Removal of subdermal implantable contraceptive devices utilizing ultrasound and fluoroscopic guidance. Cardiovasc Intervent Radiol 2019; 42(3):S360.
Cardiovasc Intervent Radiol
Learning objectives: 1. Indications for subdermal contraceptive device removal. 2. IR role in removal of subdermal contraceptive device. 3. Techniques for removal under US and fluoroscopic guidance. Background: Implantable subdermal contraceptive devices, such as the Nexplanon (etonogestrel) implant have become popular. Synthetic progestin is released to prevent ovulation and pregnancy for up to 3 years. Indications for removal include; side effects, expiration, or the patient wanting to become pregnant. The device is placed subcutaneously within the arm, between the biceps and triceps muscle. In the outpatient setting the device must be palpated to be safely removed. An advantage of the Nexplanon device over prior versions is the inclusion of a radiopaque localizer, aiding in localization when the device is erroneously placed within deep tissues. Interventional Radiology may be consulted for localization and removal using various techniques including the use of ultrasound and fluoroscopy. Clinical Findings/Procedure Details: We present six cases of women with subdermal contraceptive devices, that were unable to be removed by gynecology. The implants in all the 6 of cases were successfully removed by interventional radiology using ultrasound and/or fluoroscopic guidance. 4 patients were done using ultrasound guidance only and two had both ultrasound and fluoroscopic guidance. All were performed under local anesthesia. 3 of the 6 patients received mild IV sedation in addition to the local anesthesia. Conclusion: Implantable subdermal contraceptive devices are increasingly popular. Due to deep implantation, these devices are not always able to be removed by gynecologists. In these instances Interventional radiology can use ultrasound and fluoroscopic guidance to safely remove subdermal contraceptive devices.