Vascular access devices and methods of their use are provided. In one embodiment, a vascular access device includes a catheter (112) and at least one deployable wire (134). The catheter includes a primary lumen extending from a proximal end to a distal end of the catheter. The at least one deployable wire is secured to the catheter and configured to move relative to the catheter between a delivery configuration and a deployed configuration.

Systems and methods for positioning a wire for advancement through a vessel wall, and advancing it through one or more vessel walls, generally include a delivery catheter and an alignment catheter or a receiving catheter, and a guidewire. In some variations, the systems and methods may be used to bypass an occlusion or other barrier that may prevent advancement of a wire or tools through an endoluminal space. In these variations, the systems and methods include a delivery catheter, a bypass catheter, a receiving catheter, and a guidewire. The delivery and receiving catheters each generally include a side aperture, a deflection surface, and an alignment element, and the bypass catheter generally includes two side apertures, two deflectors, and two alignment elements. In some variations, the systems and methods may assist in treatment of a patient suffering from critical limb ischemia.

Catheter devices, assemblies and related methods for percutaneous crossing of an occlusion in a blood vessel are disclosed. A catheter device can include a central catheter, two side tubes, and a distally-protruding, curved subintimal guidewire. The central catheter can define a central lumen that extends from a proximal end to a distal end of the central catheter. The lumen can be configured to receive a primary guidewire. The central catheter can also define at least one reentry aperture oriented transverse to the central lumen. The first and second side tubes can be coupled with the central catheter, extending along a longitudinal axis thereof, with the first side tube flanking an opposite side of the central catheter relative to the second side tube. The subintimal guidewire can extend from the first side tube, distally beyond the distal end of the central catheter, to the second side tube.

Devices and methods obtain and use endovascular electrograms (or electrocardiograms/ECGs) in a number of clinical applications and settings. In one embodiment, a method for locating an indwelling medical device within a vasculature of a patient includes identifying an endovascular ECG waveform complex from an endovascular ECG signal associated with the indwelling medical device, then calculating an absolute value of the energy of the endovascular ECG waveform complex over a predetermined segment thereof. A position of the medical device within the vasculature is then determined by observation of the absolute value of the energy of the predetermined segment of the endovascular ECG waveform complex.

A catheter assembly is disclosed, comprising a proximal catheter assembly portion and a distal catheter assembly portion. The proximal catheter assembly portion includes a bifurcating hub that defines at least one fluid passageway. The distal catheter assembly portion includes a catheter tube that defines at least one lumen and includes a polymeric material. A cannula assembly is also disclosed and includes at least one cannula that is operably connected with the fluid passageway of the birfurcating hub. The cannula is further configured to operably connect with the lumen of the catheter tube so as to provide fluid communication between the proximal and distal catheter assembly portions when the two portions are connected. A polymeric coating is included with the cannula and the catheter tube, and is configured to provide a seal between the cannula and the catheter tube when the proximal and distal catheter assembly portions are connected together.

A dual tip dialysis catheter has a proximal portion with connected lumens and a distal portion with diverging lumens. The lumens may separate at a split junction and diverge in a scissors like manner to reduce or eliminate a crack or gap adjacent to the split junction, thereby reducing clotting. A dual tip dialysis catheter may have forward openings configured to direct flow in opposite directions.

A system for deploying a stent-graft from the femoral artery into the femoral vein and back into the femoral artery in order to bypass a femoral occlusion comprises a penetration catheter and a guidewire capture and stabilization catheter. The penetration catheter may be advanced contralaterally to a location above the occlusion and the capture and stabilization catheter may be introduced upwardly through the femoral vein. The penetration tool on the penetration catheter is used in multiple steps to deploy guidewires which are then used to deploy the stent-graft in the desired location.

A tunneling tool is used to create a subcutaneous tunnel for passage of a lead extension. The lead extension is transported from a proximal incision site to a distal incision site and as a result the proximal connector of the lead extension does not pass through the subcutaneous tunnel. The tunneling tool may carry the lead extension during the tunneling procedure. The tunneling tool may include a tool body that contains the lead extension as the lead extension is being carried to the distal incision site. The tunneling tool may further include a tracker tube that is present within the tool body, and the lead extension is contained in and carried by the tracker tube.

A split-tip catheter for placement within the vasculature of a patient and for use in hemodialysis or other suitable procedures. In one embodiment, the split-tip catheter includes a catheter body defining a first lumen and a second lumen, and a split distal region extending from a distal end of the catheter body. The split distal region includes an arterial segment defined by an outer wall enclosing an arterial segment lumen, the arterial segment lumen in fluid communication with the catheter body first lumen, and a venous segment defined by an outer wall enclosing a venous segment lumen, the venous segment lumen in fluid communication with the catheter body second lumen, the venous segment outer wall extending from the catheter body distal end to a distal nose portion. The distal nose portion may taper distally from a first outer perimeter to a second outer perimeter smaller than the first outer perimeter.

A recanalization catheter for facilitating re-entry into a lumen of a blood vessel from a subintimal space. The catheter includes an inflatable balloon mounted on a distal end region of the catheter shaft of the catheter. The catheter shaft includes a guidewire lumen having a distal opening and a lateral opening in a distal region of the catheter shaft proximal of the distal opening, and an inflation lumen in fluid communication with the balloon. The balloon is configured to be inflated in the subintimal space to a first inflation state at inflation pressures below a threshold inflation pressure to orient the lateral opening toward the lumen of the blood vessel, and inflated to a second inflation state at inflation pressures above the threshold inflation pressure. The catheter includes means for retaining the balloon in the first inflation state at pressures below the threshold inflation pressure.