Regulatory challenges and investigational device exemption protocols for fenestrated and branched EVAR in the United States. [Review]

MedStar author(s):
Citation: Seminars in Vascular Surgery. 35(3):374-379, 2022 Sep.PMID: 36153078Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Vascular Surgery Integrated ResidencyForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2022ISSN:
  • 0895-7967
Name of journal: Seminars in vascular surgeryAbstract: The US Food and Drug Administration (FDA) was created with the intent to ensure the safety of consumers in the United States. During the 1970s, this mandate was expanded to include medical devices. Aortic endografts, implanted since the 1990s, fall under this purview. Industry-sponsored and physician-sponsored investigation of the efficacy and safety of these devices is critical to the ongoing development of interventions for complex aortic anatomy. This research, in accordance with federal rules and regulation, must be conducted in coordination and with the approval of the FDA. The FDA has designed a process for which manufacturers or investigators may conduct efficacy and safety research using new or modified devices with oversight by the federal government. To conduct this type of research, an investigational device exemption must be obtained from the FDA. An investigational device exemption, although useful from a regulatory perspective, places a large time and financial responsibility on the investigator. As it stands now, the regulatory environment limits research into fenestrated and branched endovascular aortic repair to only those physicians and manufacturers able to provide the significant number of resources required to complete the laborious pre-application, application, and ongoing reports associated with obtaining and maintaining an investigational device exemption. Copyright © 2022. Published by Elsevier Inc.All authors: Fatima J, Rossi MJFiscal year: FY2023Digital Object Identifier: Date added to catalog: 2022-10-20
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Journal Article MedStar Authors Catalog Article 36153078 Available 36153078

The US Food and Drug Administration (FDA) was created with the intent to ensure the safety of consumers in the United States. During the 1970s, this mandate was expanded to include medical devices. Aortic endografts, implanted since the 1990s, fall under this purview. Industry-sponsored and physician-sponsored investigation of the efficacy and safety of these devices is critical to the ongoing development of interventions for complex aortic anatomy. This research, in accordance with federal rules and regulation, must be conducted in coordination and with the approval of the FDA. The FDA has designed a process for which manufacturers or investigators may conduct efficacy and safety research using new or modified devices with oversight by the federal government. To conduct this type of research, an investigational device exemption must be obtained from the FDA. An investigational device exemption, although useful from a regulatory perspective, places a large time and financial responsibility on the investigator. As it stands now, the regulatory environment limits research into fenestrated and branched endovascular aortic repair to only those physicians and manufacturers able to provide the significant number of resources required to complete the laborious pre-application, application, and ongoing reports associated with obtaining and maintaining an investigational device exemption. Copyright © 2022. Published by Elsevier Inc.

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