April 1, 2019

Erica J. Rogers
Chief Executive Officer
Silk Road Medical Inc
1213 Innsbruck Dr.
Sunnyvale, CA 94089

       Re: Silk Road Medical Inc
           Amendment No. 1 to Registration Statement on Form S-1
           Filed March 25, 2019
           File No. 333-230045

Dear Ms. Rogers:

      We have reviewed your amended registration statement and have the
following
comments. In some of our comments, we may ask you to provide us with
information so we
may better understand your disclosure.

       Please respond to this letter by amending your registration statement
and providing the
requested information. If you do not believe our comments apply to your facts
and
circumstances or do not believe an amendment is appropriate, please tell us why
in your
response.

       After reviewing any amendment to your registration statement and the
information you
provide in response to these comments, we may have additional comments. Unless
we note
otherwise, our references to prior comments are to comments in our March 18,
2019 letter.

Form S-1/A filed March 25, 2019

General

1.     Given that yours is a primary offering and the shares being offered have
not yet been
       issued, please have counsel revise the legal opinion to clarify that
shares "will be" - and
       not "have been" - legally issued, fully paid and non-assessable. Please
refer to Section
       II.B.1.a of Staff Legal Bulletin No. 19.
 Erica J. Rogers
FirstNameMedical Inc
Silk Road LastNameErica J. Rogers
Comapany NameSilk Road Medical Inc
April 1, 2019
April 2 2019 Page 2
Page 1,
FirstName LastName
Description of Capital Stock
Exclusive Forum, page 163

2.       We note your response to comment two of our prior letter. Please
revise your prospectus
         to state that there is uncertainty as to whether a court would enforce
your exclusive forum
         provision.
        You may contact Gary Newberry, Staff Accountant, at (202) 551-3761 or
Kevin Kuhar,
Accounting Branch Chief, at (202) 551-3662 if you have questions regarding
comments on the
financial statements and related matters. Please contact Sergio Chinos, Staff
Attorney, at (202)
551-7844 or Kate McHale, Staff Attorney, at (202) 551-3464 with any other
questions.



                                                              Sincerely,

                                                              Division of
Corporation Finance
                                                              Office of
Electronics and Machinery
cc:      Philip H. Oettinger