VASCULAR PROBE, VASCULAR PROBE ES

K130896 · Synovis Life Technologies, Inc. · DWP · Apr 24, 2013 · Cardiovascular

Device Facts

• Record ID: K130896
• Device Name: VASCULAR PROBE, VASCULAR PROBE ES
• Applicant: Synovis Life Technologies, Inc.
• Product Code: DWP · Cardiovascular
• Decision Date: Apr 24, 2013
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 870.4475
• Device Class: Class 2

Intended Use

The Synovis Vascular Probe is intended for use during coronary and peripheral vascular surgery to probe blood vessels distally and proximally for blockages, to measure the internal diameter of vessels, and to act as an intravascular retractor.

Device Story

Vascular Probe is a sterile, single-use, disposable surgical instrument. Device features a flexible polycarbonate or polycarbonate-polyurethane shaft with polyurethane-coated streamline bulbs of varying sizes at each end. During coronary or peripheral vascular surgery, surgeon inserts bulb into arteriotomy to probe vessel interior, identify blockages, measure internal diameter, or retract vascular wall. Device is intended for transient use (less than 15 minutes).

Clinical Evidence

No clinical data. Safety and performance were established through bench testing and biocompatibility testing in accordance with ISO 10993-1. Tensile strength testing confirmed the device meets finished device specifications.

Technological Characteristics

Materials: Polycarbonate or polycarbonate-polyurethane shaft, polyurethane-coated bulbs. Biocompatibility per ISO 10993-1. Sterile, single-use, disposable. Mechanical probe/retractor design.

Indications for Use

Indicated for use during coronary and peripheral vascular surgery to probe blood vessels for blockages, measure internal vessel diameter, and act as an intravascular retractor.

Regulatory Classification

Identification

A surgical vessel dilator is a device used to enlarge or calibrate a vessel.

Predicate Devices

• Robicsek Probe/Retractor (K910682)

Submission Summary (Full Text)

{0}------------------------------------------------

## APR 2 4 2013

## 510(K) SUMMARY

K130896

#### Applicant (Manufacturer)

Synovis Surgical Innovations, a division of Synovis Life Technologies, Inc. 2575 University Ave. W. St. Paul, MN 55114-1024 U.S.A. Ph: [phone] (Main) Fax: [phone] (Main)

#### Contact (Manufacturer)

Stephani K. Ayala Regulatory Affairs Specialist Synovis Surgical Innovations, a division of Synovis Life Technologies, Inc. 2575 University Ave. W. St. Paul, MN 55114-1024 U.S.A. Ph: [phone] (Direct) Fax: [phone] (Main) E-mail: stephani [e-mail]

## Date Submission Prepared

03/26/2013

#### Device Trade Name

- · Vascular Probe
- · Vascular Probe ES

## Common Name

Vessel Dilator, Surgical

#### Classification Name

- · Vessel Dilator, Surgical
- · 21 CFR §870.4475
- · Product Code: DWP

#### Predicate Device

Synovis Life Technologies Inc. (previously doing business as Bio-Vascular, Inc.), Robicsek Probe/Retractor; 510(k) K910682

#### Device Description

The Vascular Probe is a sterile, single use, disposable device with a polyurethane coated streamline bulb on each end of a flexible polycarbonate or polycarbonate-polyurethane shaft. The bulbs are of different size on each end of the Vascular Probe. An appropriately-sized bulb is inserted either proximally or distally through the arteriotomy to probe the interior of the vessel and may be used by the surgeon to retract the vascular wall.

The Vascular Probe is packaged in a double sterile barrier. The contents of the unopened, undamaged container are sterile.

{1}------------------------------------------------

#### Statement of Intended Use

The Synovis Vascular Probe is intended for use during coronary and peripheral vascular surgery to probe blood vessels distally and proximally for blockages, to measure the internal diameter of vessels, and to act as an intravascular retractor.

## Summary/Comparison of Technological Characteristics

The Vascular Probe is acting as its own predicate device, and is therefore substantially equivalent, having the same technological characteristics and indications for use.

A new vinyl resin utilized in the colorant of the polyurethane coating was identified for manufacturing the Vascular Probes and is the subject of this submission. The Vascular Probe is a blood contacting device. The length of time the Probe is in contact with the body is typically less than 15 minutes (i.e. transient use). Testing conducted to assure the Probe Tips, manufactured with the new vinyl resin, remain safe for its intended Biocompatibility and Tensile strength testing.

Biocompatibility testing was performed in accordance with ISO 10993-1 (Biological Evoluation of medical devices – Part 1: Evaluation and testing within a risk management process). The testing performed on the Vascular Probes demonstrated the devices continue to be biocompatible and safe for their intended use.

Tensile strength testing was conducted on the Vascular Probes manufactured with the new vinyl resin and concluded that the Probes continue to meet the current Vascular Probe finished device specifications.

#### Conclusion

The safety and performance of the Vascular Probes was evaluated through biocompatibility and bench testing. The bench testing results support the performance requirements for the Vascular Probes manufactured with the new vinyl resin. Biocompatibility testing was performed in accordance with ISO 10993-1 and demonstrated the Vascular Probes remain biocompatible.

{2}------------------------------------------------

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a stylized graphic of three human profiles facing right, stacked on top of each other. The graphic is surrounded by the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" in a circular arrangement.

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

April 24, 2013

Synovis Life Technologies, Inc. c/o Stephani Avala 2575 University Ave. W. St. Paul, MN 55114 US

Re: K130896

> Trade/Device Name: Vascular probe Regulation Number: 21 CFR 870.4475 Regulation Name: Vessel Dilator, Surgical Regulatory Class: Class II Product Code: DWP Received: April 1, 2013

Dear Stephani Avala:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug. and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA mav publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical

{3}------------------------------------------------

### Page 2 - Stephani Ayala

device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, Misbranding by reference to premarket notification (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htmfor the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

# Matthew Gallillebrenner

for

Bram D. Zuckerman, Ph.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

{4}------------------------------------------------

## 510(k) Number (if known): K130896

Device Name: Vascular Probe

## Indications for Use:

: .

The disposable Vascular Probe is intended to be used during coronary and peripheral vascular surgery to probe blood vessels distally and proximally for blockages, to measure the internal diameter of vessels, and to act as an intravascular retractor.

Prescription Use _ X Per 21 CFR 801.109

OR

Over-The-Counter Use__________________________________________________________________________________________________________________________________________________________

## PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

# Matthew G퀘咖illebrenner