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

Abstract

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.

Keywords: Endovascular approach; Foreign body; Pulmonary artery.

Fig. 1

Endovascular retrieval of a contraceptive implant in the pulmonary artery. A A CT scan in the axial section showing a contraceptive device partially located in a left lower lobe segmental artery and the left pulmonary artery (white arrow). B The patient was placed in a dorsal decubitus position in a biplane interventional room, using both left and right anterior obliquities. C After a right femoral approach, an angiogram using a 5F pigtail showed the contraceptive device (white arrows), with no visible thrombosis. D A 8F introducer was placed into the left pulmonary artery (black arrow), allowing insertion of a 6F sheath and a loop snare (black arrowhead). E After pulling the contraceptive device (white arrows) with the loop snare (white arrowhead), it was then locked in front of the sheath and the introducer (black arrow). F After removing the entire introducer, the contraceptive device (white arrows) was trapped by the loop snare (black arrow)