K Number
K173012
Device Name
ANGIO-PRESS LITE DVT Compression Device
Date Cleared
2018-05-10

(225 days)

Product Code
Regulation Number
870.5800
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Pegasus Medical Supply Inc. ANGIO-PRESS LITE DVT Compression Device is intended to increase venous blood flow in patients in order to help prevent deep vein thrombosis.
Device Description
The ANGIO-PRESS LITE DVT Compression Device is a non-invasive intermittent pneumatic compression system that aids in prevention and reduction in incidence of deep vein thrombosis (DVT). The system consists of a pump and soft pliable compression single patient use garments for leg or foot compression. The pump supplies compression on a pre-set inflation pressure of 40mmHg for calf and thigh compression, and 80mmHg for foot compression. Pressure in the garments is transferred to the extremities, augmenting venous blood flow, thus reducing stasis.
More Information

Not Found

No
The device description and performance studies focus on standard pneumatic compression technology with pre-set pressures, and there is no mention of AI or ML terms, data sets, or performance metrics typically associated with such technologies.

Yes
The device is intended to increase venous blood flow to help prevent deep vein thrombosis, which is a medical condition, making it a therapeutic device.

No
The device description states its intended use is to increase venous blood flow and prevent deep vein thrombosis, not to diagnose a condition. It is a compression therapy device.

No

The device description explicitly states the system consists of a pump and compression garments, which are hardware components.

Based on the provided information, the Pegasus Medical Supply Inc. ANGIO-PRESS LITE DVT Compression Device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is to "increase venous blood flow in patients in order to help prevent deep vein thrombosis." This is a therapeutic and preventative action performed directly on the patient's body.
  • Device Description: The device is described as a "non-invasive intermittent pneumatic compression system" that applies pressure to the extremities. This is a physical intervention, not a test performed on samples taken from the body.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting analytes, or providing diagnostic information based on laboratory testing.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. The ANGIO-PRESS LITE operates externally on the patient to influence physiological processes.

N/A

Intended Use / Indications for Use

The Pegasus Medical Supply Inc. ANGIO-PRESS LITE DVT Compression Device is intended to increase venous blood flow in patients in order to help prevent deep vein thrombosis.

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

JOW

Device Description

The ANGIO-PRESS LITE DVT Compression Device is a non-invasive intermittent pneumatic compression system that aids in prevention and reduction in incidence of deep vein thrombosis (DVT).

The system consists of a pump and soft pliable compression single patient use garments for leg or foot compression. The pump supplies compression on a pre-set inflation pressure of 40mmHg for calf and thigh compression, and 80mmHg for foot compression. Pressure in the garments is transferred to the extremities, augmenting venous blood flow, thus reducing stasis.

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)

A series of safety and performance tests were conducted on the subject device, ANGIO-PRESS LITE DVT Compression Device.

  • . Biocompatibility
  • Software Validation
  • . Electromagnetic compatibility and electrical safety
  • Reliability
  • . Performance
  • . Usability

All the test results demonstrate ANGIO-PRESS LITE DVT Compression Device meets the requirements of its pre-defined acceptance criteria and intended use, and is substantially equivalent to the predicate device.

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.

K143202

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

§ 870.5800 Compressible limb sleeve.

(a)
Identification. A compressible limb sleeve is a device that is used to prevent pooling of blood in a limb by inflating periodically a sleeve around the limb.(b)
Classification. Class II (performance standards).

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo includes the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue text.

May 10, 2018

Pegasus Medical Supply, Inc. Pao-Ming Shih General Manager No. 27-1, Ln. 473, Sec. 2, Hezun N. Rd., Zhongli City Taoyuan County, 32060 Tw

Re: K173012

Trade/Device Name: ANGIO-PRESS LITE DVT Compression Device Regulation Number: 21 CFR 870.5800 Regulation Name: Compressible Limb Sleeve Regulatory Class: Class II Product Code: JOW Dated: April 17, 2018 Received: April 18, 2018

Dear Pao-Ming Shih:

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 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); medical device reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820);

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and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Nicole G. Ibrahim -S

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

Enclosure

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Indications for Use

510(k) Number (if known)

K173012

Device Name ANGIO-PRESS LITE DVT Compression Device

Indications for Use (Describe)

The Pegasus Medical Supply Inc. ANGIO-PRESS LITE DVT Compression Device is intended to increase venous blood flow in patients in order to help prevent deep vein thrombosis.

Type of Use (Select one or both, as applicable)
Prescription Use (Part 21 CFR 801 Subpart D)×
Over-The-Counter Use (21 CFR 801 Subpart C)

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Pegasus Medical Supply, Inc. ANGIO-PRESS LITE DVT Compression Device Traditional 510(k), K173012/S003 Section 5 - 510(k) Summary

510(k) SUMMARY

5.1Type of Submission:Traditional
5.2Date of Summary:May 9, 2018
5.3Submitter:
Address:Pegasus Medical Supply, Inc.
No.27-1, Ln. 473, Sec. 2, Hezun N. Rd., Zhongli
City, Taoyuan County 32060, Taiwan (R.O.C.)
Phone:+886-3-2753341
Fax:+886-3-4616802
Contact:PAO-MING SHIH
(borisshih(@pegasus-pms.com)

5.4 Identification of the Device:

Proprietary/Trade name:ANGIO-PRESS LITE DVT
Compression Device
Classification Product Code:JOW
Regulation Number:870.5800
Regulation Description:Compressible limb sleeve
Review Panel:Cardiovascular
Device Class:II

Identification of the Predicate Device: 5.5

Predicate Device Name:ANGIO-PRESS DVT Compression
Device Model Name: IPCS
Manufacturer:Pegasus Medical Supply, Inc.
Classification Product Code:JOW
Regulation number:870.5800
Device Class:II
510(k) Number:K143202

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5.6 Intended Use/ Indications for Use of the Device

The Pegasus Medical Supply Inc. ANGIO-PRESS LITE DVT Compression Device is intended to increase venous blood flow in patients in order to help prevent deep vein thrombosis.

5.7 Device Description

The ANGIO-PRESS LITE DVT Compression Device is a non-invasive intermittent pneumatic compression system that aids in prevention and reduction in incidence of deep vein thrombosis (DVT).

The system consists of a pump and soft pliable compression single patient use garments for leg or foot compression. The pump supplies compression on a pre-set inflation pressure of 40mmHg for calf and thigh compression, and 80mmHg for foot compression. Pressure in the garments is transferred to the extremities, augmenting venous blood flow, thus reducing stasis.

5.8 Non-clinical Testing

A series of safety and performance tests were conducted on the subject device, ANGIO-PRESS LITE DVT Compression Device.

  • . Biocompatibility
  • Software Validation
  • . Electromagnetic compatibility and electrical safety
  • Reliability
  • . Performance
  • . Usability

All the test results demonstrate ANGIO-PRESS LITE DVT Compression Device meets the requirements of its pre-defined acceptance criteria and intended use, and is substantially equivalent to the predicate device.

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5.9 Clinical Testing

No clinical test data was used to support the decision of substantial equivalence.

5.10 Substantial Equivalence Determination

The ANGIO-PRESS LITE DVT Compression Device submitted in this 510(k) file is substantially equivalent in intended use, design, technology/principles of operation, materials and performance to the cleared ANGIO-PRESS DVT Compression Device Model Name: IPCS (K143202). Differences between the devices cited in this section do not raise any new issue of substantial equivalence.

| Item | Subject device | Predicate device | Substantial
equivalence
determination |
|--------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------|
| Proprietary Name | ANGIO-PRESS LITE DVT
Compression Device | ANGIO-PRESS DVT Compression
Device | N/A |
| Model Name | ANGIO-PRESS LITE | IPCS | |
| 510(k) No. | (to be assigned) | K143202 | |
| Intended Use | The Pegasus Medical Supply Inc.
ANGIO-PRESS LITE DVT
Compression Device is intended to
increase venous blood flow in
patients in order to help prevent
deep vein thrombosis. | The Pegasus Medical Supply Inc.
ANGIO-PRESS IPCS Deep Vein
Thrombosis (DVT) Compression
Devices is intended to increase
venous blood flow in patients in
order to help prevent deep vein
thrombosis. | Same |
| Type of use | Prescription Use | Prescription Use | Same |
| For Control Unit (Pump) | | | |
| Size (L x W x H) | 26 x 10.5 x 16 cm | 31.5 x 11 x 19.5 cm
(12.6" x 4.3" x 7.7") | Different but does
not impact safety
and effectiveness
of subject device |
| Weight | 2.5 Kg | 3.1 Kg | Different but does |
| | | | not impact safety
and effectiveness
of subject device |
| Pressure Range | Calf/Thigh: 40 mmHg
Foot: 80 mmHg | Calf/Thigh: 40 mmHg
Foot: 80 mmHg | Same |
| Input Rating | AC 110-120V, 60Hz | AC 100-240V, 50/60Hz | Different but does
not impact safety
and effectiveness
of subject device |
| Fuse Rating | T1AL 250V | 1A/250V | Different but does
not impact safety
and effectiveness
of subject device |
| IEC Classification | Class II, Type BF
Not AP or AGP type | Class I Type BF
Not AP or APG type | Different but does
not impact safety
and effectiveness
of subject device |
| Ingress of Water
Protection | IP21 | N/A | Different but does
not impact safety
and effectiveness
of subject device |
| Operation Humidity | 30% to 75% non-condensing | 30 - 75% | Same |
| Operation
Temperature | 15°C - 40°C | 15°C - 35°C | Different but does
not impact safety
and effectiveness
of subject device |
| Operation
Atmospheric
Pressure Range | 700 hPa to 1060 hPa | 700 hPa to 1060 hPa | Same |
| Mode of Operation | Continuous | Continuous | Same |
| Applied Part | Garment and Air Tubing | Garment and Air Hose | Same |
| Applied Mode of | Intermittent | Intermittent | Same |

6

Pegasus Medical Supply, Inc.

ANGIO-PRESS LITE DVT Compression Device

Traditional 510(k), K173012/S003

7

Pegasus Medical Supply, Inc.

ANGIO-PRESS LITE DVT Compression Device

Traditional 510(k), K173012/S003

Pressure
Inflation time12 seconds12 secondsSame
per chamber
Deflation time48 seconds48 secondsSame
per chamber
Airflow≧ 6.0 L/min≧ 6.0 L/minSame
SoftwareDifferent but does
w/o Timer and Pressure displayw/ Timer and Pressure displaynot impact safety
Control Panelw/o Reset Timer functionw/ Reset Timer functionand effectiveness
of subject device
For Applied Part
Calf Garments
(For calf
circumference)
Thigh Garments
(For thigh
circumference)SmallUp to 14"Extra Small35 cm
(XS)
Medium
LargeUp to 18"
Up to 24"Small43 cmDifferent but does
(名)not impact safety
Medium
(M)48 cmand effectiveness
of subject device
Bariatric
MediumUp to 32"
Up to 29"Bariatric81 cm
71 cm
(B)
MediumDifferent but does
(M)not impact safety
LargeUp to 36"Large89 cmand effectiveness
BariatricUp to 42"(L)of subject device
Foot Garments
(For US men's size)StandardUp to 13RegularSize 7 - 9Different but does
(U)not impact safety
LargeOver 13LargeSize 9 - 11and effectiveness
(L)of subject device
Air Tubing /
Air HoseReplacement tubing, 60" and 120"Air hose extension of
1.5, 3, and 4.5 metresDifferent but does
not impact safety
and effectiveness
of subject device

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5.11 Similarity and Difference

The ANGIO-PRESS LITE DVT Compression Device has been compared with "ANGIO-PRESS DVT Compression Device Model Name: IPCS". The subject device has same intended use, principle of operation and similar technological characteristics as the predicate device. Although there are some specifications that are different between two devices, the performance test has been completed to demonstrate that the differences between these parameters would not impact the safety and effectiveness of the subject device. The subject device has undergone safety and performance tests, and the results complied with the test requests. Therefore, the difference between the subject device and the predicate device did not raise any problem of substantial equivalence. The subject device is substantially equivalent to the predicate device in intended use, safety and performance claims.

5.12 Conclusion

After analyzing non-clinical laboratory studies and safety testing data, it can be concluded that the ANGIO-PRESS LITE DVT Compression Device is substantially equivalent to the predicate device.