BIOTRONIK AG, BUELACH, SWITZERLAND PASSEO-35 7/40/80; CATHETER, ANGIOPLASTY, PERIPHERAL, TRANSLUMINAL
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Model Number 357290 |
Device Problem
Material Puncture/Hole (1504)
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Patient Problem
No Consequences Or Impact To Patient (2199)
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Event Date 12/27/2019 |
Event Type
malfunction
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Event Description
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The passeo-35 balloon was selected for treatment of a severely calcified lesion in the iliac artery.The device was placed in the target lesion.During inflation at 5 bar, the balloon lost pressure.After removal, a pinhole was detected.A second passeo-35 with same size but another lot number was used and the same problem occurred.
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Manufacturer Narrative
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The returned instrument was subjected to a technical analysis and the corresponding production documentation was reviewed to establish whether a deviation from the manufacturing process could be the cause for the reported event.The technical investigation of the returned device revealed a fine jet of water in the medial balloon part when applying a pressure.The microscopic analysis of the balloon surface showed a microscopic leakage and scratches on the balloon surface nearby the damage site.It seems likely that the damage of the balloon surface was caused by a hard, sharp-edged object pressing against the balloon from the outside.Review of the production documentation confirmed that the instrument was manufactured according to specifications and passed all in-process and final inspections.In addition to visual inspections each instrument is tested for air tightness by means of a helium leak test and a pressure test.We can therefore confirm that the instrument was delivered in a leak-proof condition.Based on the conducted investigations, no manufacturing or material related root cause could be determined.The root cause is most likely related to the patients anatomy.
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