MAUDE Adverse Event Report: BOLTON MEDICAL, INC. RELAY PRO NBS THORACIC STENT-GRAFT SYSTEM; STENT, ENDOVASCULAR GRAFT, AORTIC

Catalog Number 28-N4-38-109-38U

Device Problems Difficult to Insert (1316); Detachment of Device or Device Component (2907); Difficult to Advance (2920)

Patient Problems Foreign Body In Patient (2687); No Clinical Signs, Symptoms or Conditions (4582)

Event Date 11/09/2023

Event Type  Injury  

Manufacturer Narrative

Bolton medical, inc.(d/b/a terumo aortic), herein known as the "company", is submitting this report pursuant to 21 cfr part 803, has made reasonable efforts to obtain complete information, and has provided as much as is available to the company as of the submission date of this report.This report is based on information obtained by the company, which may not have been able to fully investigate or verify prior to the date the report was required by the regulations.Any required fields that are unpopulated are blank because the information is currently unknown, unavailable, or not applicable.This report does not constitute an admission or a conclusion by anyone that the device caused or contributed to the event described in the report.In particular, this report does not constitute a legal admission by anyone that the product described in this report has any defects or has malfunctioned, as defined from a legal standpoint.These words are included in the report and are fixed items for selection created by the certain regulations, to categorize the type of event solely for the purpose of reporting pursuant to part 803.This statement should be included with any information or report disclosed to the public under the freedom of information act.

Event Description

"successful implantation of device to seal a type 1b endoleak from a previously implanted medtronic thoracic graft.Our relay pro initially struggled to get through tough access and a previously implanted aaa graft (unknown).The physicians did notice a kink in the wire as well which helped contribute to this.It took a lot of manipulation and twisting to get the device into the aorta.It eventually traversed and deployed without any problems.As we brought the delivery system out of the body, we noticed that the nose cone had come off the device and was lodged in the external iliac.The physicians performed a cutdown and removed the nose cone and then patched the artery.There was no issue with the patient and all was fine after.The devices have been saved for return and inspection.We suspect that the manipulation and wire kink helped untwist the nose cone off of the delivery system." patient outcome: "no injury to the patient.".

Manufacturer Narrative

Bolton medical, inc.(d/b/a terumo aortic), herein known as the "company", is submitting this report pursuant to 21 cfr part 803, has made reasonable efforts to obtain complete information, and has provided as much as is available to the company as of the submission date of this report.This report is based on information obtained by the company, which may not have been able to fully investigate or verify prior to the date the report was required by the regulations.Any required fields that are unpopulated are blank because the information is currently unknown, unavailable, or not applicable.This report does not constitute an admission or a conclusion by anyone that the device caused or contributed to the event described in the report.In particular, this report does not constitute a legal admission by anyone that the product described in this report has any defects or has malfunctioned, as defined from a legal standpoint.These words are included in the report and are fixed items for selection created by the certain regulations, to categorize the type of event solely for the purpose of reporting pursuant to part 803.This statement should be included with any information or report disclosed to the public under the freedom of information act.

Event Description

"successful implantation of device to seal a type 1b endoleak from a previously implanted medtronic thoracic graft.Our relay pro initially struggled to get through tough access and a previously implanted aaa graft (unknown).The physicians did notice a kink in the wire as well which helped contribute to this.It took a lot of manipulation and twisting to get the device into the aorta.It eventually traversed and deployed without any problems.As we brought the delivery system out of the body, we noticed that the nose cone had come off the device and was lodged in the external iliac.The physicians performed a cutdown and removed the nose cone and then patched the artery.There was no issue with the patient and all was fine after.The devices have been saved for return and inspection.We suspect that the manipulation and wire kink helped untwist the nose cone off of the delivery system." patient outcome: "no injury to the patient.".

• Brand Name: RELAY PRO NBS THORACIC STENT-GRAFT SYSTEM
• Type of Device: STENT, ENDOVASCULAR GRAFT, AORTIC
• Manufacturer (Section D): BOLTON MEDICAL, INC.; 799 international parkway; sunrise FL 33325
• Manufacturer Contact: megan indeglia ; 799 international parkway; sunrise, FL 33325 ; 9548389699
• MDR Report Key: 18292547
• MDR Text Key: 330058886
• Report Number: 2247858-2023-00305
• Device Sequence Number: 1
• Product Code: MIH
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P200045
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 01/19/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Catalogue Number: 28-N4-38-109-38U
• Device Lot Number: 2308190296
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 11/09/2023
• Initial Date FDA Received: 12/08/2023
• Supplement Dates Manufacturer Received: 11/09/2023
• Supplement Dates FDA Received: 01/19/2024
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 09/01/2023
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Sex: Female