MAUDE Adverse Event Report: LEMAITRE VASCULAR, INC. SINGLE LUMEN EMBOLECTOMY CATHETER

Catalog Number 1601-68

Device Problem Unintended Movement (3026)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 04/29/2019

Event Type  malfunction  

Manufacturer Narrative

We have received the complaint device for evaluation and we have confirmed the reported incident.The proximal ligature was observed to have partially unwound.The balloon was observed to have partially inflated beyond the inflation holes.As a result, the user could not deflate the balloon.The distal ligature was properly binding onto the shaft of the catheter.No necking or kinking of the extrusion was observed.We have conducted a lot history review and did not find any issues noted in the manufacturing or packaging process that could be related to this issue.All qc tests passed their requirements.Further, we have not received any other complaints of a similar nature for devices from this lot.As part of our manufacturing process, a 100% visual balloon and winding inspection are performed on the manufactured product.However, it is possible that the tension or the glue applied underneath the balloon during the balloon tying process was inadequate resulting in the slippage of the ligature from its position.It is also possible that some anatomical or procedural factors may have contributed to the ligature failure while removing the adherent material from the patient's narrowed blood vessel.As stated in our ifu, the arterial embolectomy catheter is not recommended for the removal of fibrous, adherent or calcified material ( eg.Chronic clot, atherosclerotic plaque ).This catheter is not designed to withstand the additional pull force needed to remove these materials.There was no injury to the patient as the result of this incident.Another lemaitre over-the-wire embolectomy catheter was used to complete the procedure.

Event Description

During thrombectomy of arteriovenous fistula of upper limb prosthesis, surgeon observed that he could not deflate the balloon of the single lumen catheter.The malfunction was detected after removing a part of the thrombus while the catheter was outside the patient's blood vessel.There was no injury to the patient as the result of this incident.

• Brand Name: SINGLE LUMEN EMBOLECTOMY CATHETER
• Type of Device: EMBOLECTOMY CATHETER
• Manufacturer (Section D): LEMAITRE VASCULAR, INC.; 63 second ave; burlington MA 01803
• Manufacturer (Section G): LEMAITRE VASCULAR, INC.; 63 second ave; burlington MA 01803
• Manufacturer Contact: pragya thikey ; 63 second ave; burlington, MA 01803 ; 7812212266
• MDR Report Key: 8775437
• MDR Text Key: 150865915
• Report Number: 1220948-2019-00086
• Device Sequence Number: 1
• Product Code: DXE
• UDI-Device Identifier: 00840663100521
• UDI-Public: 00840663100521
• Combination Product (y/n): N
• Reporter Country Code: BR
• PMA/PMN Number: K992368
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 07/09/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: 1601-68
• Device Lot Number: SLC4701
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/25/2019
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 06/12/2019
• Initial Date FDA Received: 07/10/2019
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 08/16/2018
• 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