MAUDE MDR 6498793

MDR report key
6498793
Report number
3007284313-2017-00092
Event key
0
Event type
3
Date of event
2016-10-01
Date received
2017-04-17
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MARCI STEWART
Address
1500 N. 4TH STREET FLAGSTAFF AZ
Phone
928-928-9285
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1GORE VIATORR? TIPS ENDOPROSTHESISSHUNT, PORTOSYSTEMIC, ENDOPROSTHESISW.L. GORE & ASSOCIATESMIRR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-04-1701. O; 2. R

Event Narratives#

N

Patient 1

A DEVICE LOT NUMBER WAS NOT PROVIDED; THEREFORE, AN INVESTIGATION WAS UNABLE TO BE PERFORMED AND A CAUSE OF THE REPORTED EVENT WAS UNABLE TO BE DETERMINED. GREEN, MICHAEL S., AHMED, BRITTANY, BOURM, KELSEY, COFFEY, CHARLES, SALYERS, WILLIAM. SEPTIC THROMBUS OF A TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS) RESULTING IN PSOAS MUSCLE ABSCESS: A CASE REPORT OF ENDOTIPSITIS. AMERICAN JOURNAL OF GASTROENTEROLOGY. 2016; 111:S897 ISSN: 15720241.

D

Patient 1

THIS INFORMATION WAS RECEIVED THROUGH ABSTRACT "SEPTIC THROMBUS OF A TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS) RESULTING IN PSOAS MUSCLE ABSCESS: A CASE REPORT OF ENDOTIPSITIS" PUBLISHED IN THE AMERICAN JOURNAL OF GASTROENTEROLOGY, 2016. THE ABSTRACT PRESENTS A CASE OF AN INFECTED TIPS THROMBOSIS THAT EXTENDED THROUGH THE INFERIOR VENA CAVA (IVC) INTO THE RIGHT ATRIUM AND RESULTED IN RIGHT PSOAS MUSCLE ABSCESS. THE ABSTRACT STATES "AN (B)(6) MALE WITH A HISTORY OF CRYPTOGENIC CIRRHOSIS REQUIRING TIPS FOR DIURETIC RESISTANT ASCITES WHO HAD SUFFERED A COMPLICATED COURSE INVOLVING MULTIPLE IN-STENT STENOSIS NECESSITATING REPEAT TIPS AND REVISION PRESENTED TO AN OUTSIDE FACILITY ED WITH INCREASING ABDOMINAL GIRTH AND BACK DISCOMFORT TWO WEEKS AFTER UNDERGOING A SECOND REVISION WITH SUCCESSFUL PLACEMENT OF A VIATORR STENT. A CONTRAST-ENHANCED COMPUTED TOMOGRAPHY (CT) SCAN OF THE ABDOMEN APPEARED TO DISPLAY CONTRAST WITHIN THE SECOND TIPS AND NO OTHER ABNORMALITIES. ALTHOUGH AT THIS TIME NO DOPPLER STUDY WAS PERFORMED AND THE PATIENT WAS DISCHARGED TO HOME. THREE DAYS LATER THE PATIENT RETURNED WITH WORSENING BACK PAIN. AT THAT TIME, CONTRAST-ENHANCED CT REVEALED AN OCCLUDING THROMBUS EXTENDING FROM THE ORIGIN OF THE MAIN PORTAL VEIN TO THE RIGHT ATRIUM, ALONG WITH SCATTERED THROMBI IN THE INFRARENAL IVC. A NEW FLUID COLLECTION WAS ALSO SEEN IN THE LEFT PSOAS. DRAINAGE OF THE PSOAS ABSCESS WAS PERFORMED. TWO BLOOD CULTURES AND ABSCESS FLUID CULTURE GREW STAPHYLOCOCCUS HOMINIS. THE PATIENT WAS TRANSFERRED TO A FACILITY EQUIPPED FOR COMPLEX ENDOVASCULAR PROCEDURES AND UNDERWENT AN IR-GUIDED THROMBOLYSIS OF THE IVC THROMBUS WITH TIPS REVISION. THE PATIENT SUBSEQUENTLY IMPROVED AND WAS DISCHARGED HOME WITH SUBCUTANEOUS ENOXAPARIN FOR ANTICOAGULATION AND FOUR WEEKS OF IV CEFTRIAXONE FOR BACTEREMIA."