Manufacturing review: a review of manufacturing records was not performed, as additional complaints have not been reported for this lot.Based on the information available it is not reasonably suggested that a manufacturing process may have caused or contributed to the reported issue.However, the lot history records of this lot were reviewed with special attention to the manufacturing and inspection of this product and the product was found to have met the specification prior to shipment.Investigation summary: the sample was returned to the manufacturer for evaluation.Based on the investigation of the returned catheter sample it was confirmed that the user could only partially deploy the stent graft.The stent graft was found partially deployed and the outer sheath was found with elongation in the proximal section which indicated that increased friction/ release affected the system during deployment attempt.An indication for a process related issue could not be found.In this case the vessel was not tortuous or calcified, and the lesion was pre dilated.The system was flushed and the proximal end of the stent was paced in straight position.Based on the information available a definite root cause for the reported event could not be determined.Labeling review:in reviewing the relevant labeling for this product, it was found that the instructions for use (ifu) sufficiently address the potential risks.Regarding preparation of the device the ifu state that prior to loading the endovascular system over a guide wire, both ports must be flushed with sterile saline flushing these lumens will also facilitate stent graft deployment.Regarding the anatomy of the placement site the ifu states: prior to stent graft deployment, ensure that the proximal (inflow) stent graft end is positioned in a straight section of the lumen to reduce the risk of higher deployment forces and possible endovascular system failure.The ifu further state: 'if unusual resistance or high deployment force is encountered during stent graft deployment, abort the procedure, remove the delivery system and use an alternative device.' d4(expiry date: 11/2022).H11:section a through f - the information provided by bd represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.
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