K Number
K032204
Device Name
MODIFICATION TO VASCULAR SOLUTIONS VARI-LASE ENDOVENOUS LASER PROCEDURE KIT
Date Cleared
2003-08-20

(33 days)

Product Code
Regulation Number
878.4810
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The VARI-LASE procedure kit is indicated for the treatment of varicose veins and varicosities associated with superficial reflux of the Greater Saphenous Vein.
Device Description
The VARI-LASE procedure kit contains a 600µm fiber and may contain one ore more of the following accessories used to gain endovascular access: 0.035" / stainless steel guide wire (lengths from 75 to 150cm) 5Fr/25 or 45cm introducer sheath 19 Gauge/7cm Percutaneous Entry Needle or Micropuncture Kit
More Information

Not Found

No
The summary describes a procedure kit with a fiber and accessories for endovascular access, with no mention of AI or ML in the intended use, device description, or performance studies.

Yes
The device is indicated for the treatment of varicose veins and varicosities, which are medical conditions, and thus serves a therapeutic purpose.

No
Explanation: The "Intended Use / Indications for Use" states that the device is "indicated for the treatment of varicose veins," indicating a therapeutic purpose rather than a diagnostic one.

No

The device description explicitly lists physical components like a fiber, guide wire, introducer sheath, and needle, indicating it is a hardware-based medical device kit.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for the treatment of varicose veins and varicosities. This is a therapeutic procedure performed directly on the patient's body.
  • Device Description: The device components (fiber, guide wire, sheath, needle) are all used for accessing and treating the vein in vivo.
  • Lack of Diagnostic Elements: There is no mention of the device being used to analyze samples (blood, tissue, etc.) or to provide diagnostic information about a patient's condition. IVDs are used to diagnose diseases or conditions.

Therefore, this device is a therapeutic medical device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The VARI-LASE procedure kit is indicated for the treatment of varicose veins and varicosities associated with superficial reflux of the Greater Saphenous Vein.

Product codes (comma separated list FDA assigned to the subject device)

GEX

Device Description

The VARI-LASE procedure kit contains a 600µm fiber and may contain one ore more of the following accessories used to gain endovascular access: 0.035" / stainless steel guide wire (lengths from 75 to 150cm) 5Fr/25 or 45cm introducer sheath 19 Gauge/7cm Percutaneous Entry Needle or Micropuncture Kit

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

No testing was required to document the safety and effectiveness of this modified procedure kit.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K000737

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 878.4810 Laser surgical instrument for use in general and plastic surgery and in dermatology.

(a)
Identification. (1) A carbon dioxide laser for use in general surgery and in dermatology is a laser device intended to cut, destroy, or remove tissue by light energy emitted by carbon dioxide.(2) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by light energy emitted by argon.
(b)
Classification. (1) Class II.(2) Class I for special laser gas mixtures used as a lasing medium for this class of lasers. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 878.9.

0

K032204 1 of 1

:

AUG 2 0 2003

510(K) SUMMARY

Common/Usual Name:Laser Instrument Fiber and Procedure Kit
Product Trade Name:Vari-Lase Endovenous Laser Procedure Kit
Classification Name:Laser Surgical Instrument for use in General and Plastic
Surgery and in Dermatology
21 CFR 878-4810 (Product Code GEX)
Manufacturer:Vascular Solutions, Inc.
6464 Sycamore Court
Minneapolis, Minnesota 55369
Establishment Registration:2134812
Contact:Deborah Jensen
V. P., Regulatory Affairs, Clinical Affairs, and Quality
Systems
(763) 656-4349 phone
(763) 656-4250 fax
Performance Standards:No performance standards have been developed under
section 514 for this device.
Device Description:The VARI-LASE procedure kit contains a 600µm fiber and
may contain one ore more of the following accessories used
to gain endovascular access:
0.035" / stainless steel guide wire (lengths from 75 to
150cm)
5Fr/25 or 45cm introducer sheath
19 Gauge/7cm Percutaneous Entry Needle or
Micropuncture Kit
Intended Use:The VARI-LASE procedure kit is indicated for the
treatment of varicose veins and varicosities associated with
superficial reflux of the Greater Saphenous Vein.
Summary of Non-Clinical Testing:No testing was required to document the safety and
effectiveness of this modified procedure kit.
Predicate Devices:VARI-LASE Procedure Kit (K000737)
Conclusions:The VARI-LASE Procedure Kit is substantially equivalent
to the currently marketed VARI-LASE kit based on a
comparison of the indications for use and the components
supplied and the technological characteristics of the
supplied components.

1

Image /page/1/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized depiction of an eagle or bird with outstretched wings. The bird is facing to the right. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular pattern around the bird.

AUG 2 0 2003

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Ms. Deborah Jensen Vice President, Regulatory Affairs, Clinical Affairs and Quality Systems Vascular Solutions, Inc. 6464 Sycamore Court Minneapolis, Minnesota 55369

Re: K032204

Trade/Device Name: Vascular Solutions Vari-Lase™ Endovenous Laser Products Kit Regulation Number: 21 CFR 878.4810 Regulation Name: Laser surgical instrument for use in general and plastic surgery and in dermatology Regulatory Class: II Product Code: GEX Dated: July 17, 2003 Received: July 23, 2003

Dear Ms. Jensen:

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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such 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 may 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); 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.

2

Page 2 - Ms. Deborah Jensen

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (301) 594-4659. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). 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 (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Sincerely yours,

Mark N Millman

Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

Indications for Use Statement

510(k) Number:

K032209

Device Name:

Vascular Solutions Vari-Lase™ Endovenous Laser Procedure Kit

Indications for Use:

The VARI-LASE procedure kit is indicated for the treatment of varicose veins and varicosities associated with superficial reflux of the Greater Saphenous Vein.

Mark N. Milliken
(Division Sign-Off)

Division of General, Restorative and Neurological Devices

KO32204 510(k) Number ________________________________________________________________________________________________________________________________________________________________

2