MAUDE Adverse Event Report: LEMAITRE VASCULAR, INC. LEMAITRE OVER-THE-WIRE EMBOLECTOMY CATHETER

Model Number	1651-38
Medical Device Problem Code	Deflation Problem (1149)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	02/26/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
We have not received the complaint device for evaluation since the device has been discarded by the user.Hence, we could not conclusively determine the root cause of the incident.During our follow-up investigation with the complainant, we learned that the surgeon had tested the catheter before use and he found it to be operational.Surgeon had made multiple passes to remove the clot from the patient's vessel before encountering the deflation issue with the balloon.He was able to remove the undeflated balloon from the patient's vessel without requiring any surgical intervention.He further stated that the balloon was operated in a patient with stenotic vessel.There were no fragments left over inside the patient's vessel when he removed the catheter from the patient's vessel.Surgeon felt resistance when removing the thrombus and he clearly stated that the catheter may have been used with excessive force.Our review of the lot history records for this lot did not find any discrepancies either in the manufacturing or packaging process that could be related to this incident.Further, we have not received any other complaints of a similar nature for devices from this lot.Based on the information provided, the device performed properly during initial use.The issue might have occurred when removing the residual adherent thrombus from the patient's vessel.It is also possible that some anatomical (calcification or stenosis in the lesion area ) or procedural factors ( use of excessive force to remove the thrombus) may have contributed to the balloon failure.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.Please note that we have also submitted manufacturer incident report# 1220948-2020-00039 related to another similar incident that occurred during the same case following the aforementioned incident.
Event or Problem Description
During a thrombectomy procedure, the balloon of an over-the-wire embolectomy catheter failed to deflate.Surgeon had to pull the catheter to remove the undeflated balloon from the patient's vessel.There was no injury to the patient as the result of this incident.This is report 1 of 2.

• Brand Name: LEMAITRE OVER-THE-WIRE EMBOLECTOMY CATHETER
• Common Device Name: EMBOLECTOMY CATHETER
• Manufacturer (Section D): LEMAITRE VASCULAR, INC.; 63 second ave; burlington, ma
• MDR Report Key: 9875534
• Report Number: 1220948-2020-00038
• Device Sequence Number: 14150521
• Product Code: DXE
• UDI-Device Identifier: 00840663100668
• UDI-Public: 00840663100668
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K022145
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 03/24/2020

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
• Operator of Device: Health Professional
• Device Expiration Date: 08/28/2025
• Device Model Number: 1651-38
• Device Catalogue Number: 1651-38
• Device Lot Number: OTW4278
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/26/2020
• Initial Report FDA Received Date: 03/24/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Congenital Anomaly