A subintimal recanalization catheter, including an elongate shaft including a first tubular member and a penetration member slidably disposed in a lumen of the first tubular member. The penetration member includes a distal tip positioned proximal of a distal nose of the first tubular member. The distal nose of the first tubular member includes a ramp and a guide wire lumen extending through the distal nose of the first tubular member. Longitudinal movement of the penetration member relative to the first tubular member causes the penetration member to contact the ramp to direct the distal tip of the penetration member away from the first tubular member.

Peritoneal dialysis is delivered via implementation of the total implantable system disclosed. The system is composed of several components. The extended surface area port, equipped with an internal support pillar, is implanted beneath the subcutaneous tissue. The catheter portion is tunneled under the subcutaneous tissue until it reaches the abdomen where it enters the peritoneal cavity. The distal/terminating end of the catheter resides in the peritoneal cavity and is designed with an inner perforated distal catheter, circumferentially enclosed by an outer perforated sheath, creating an anti-occlusion technology system. The distal end of the sheath is designed with an anti-clog tip. Port and system access is achieved via hypodermic needle. Dialysis solution is infused and evacuated via the same modalities.

A method of diverting fluid flow from a first vessel including an occlusion to a second vessel includes deploying a prosthesis at least partially in a fistula and making valves in the second vessel incompetent. Making the valves in the second vessel incompetent includes at least one of using a reverse valvulotome to cut the valves, inflating a balloon, expanding a stent, and lining the second vessel with a stent.

A method for positioning an endovascular device in or near the heart using electrocardiogram (ECG) signals. The method includes receiving an endovascular ECG signal including a plurality of waveforms, processing the endovascular ECG signal to calculate a P-wave amplitude and a spectral power for each predetermined time period, determining a maximum P-wave amplitude and an associated maximum spectral power, associating the maximum P-wave amplitude and the maximum spectral power with a predetermined location in or near the heart, calculating a location based on a ratio of the P-wave amplitude to the maximum P-wave amplitude and a ratio of the spectral power to the maximum spectral power, and displaying the location to a user.

Devices and methods obtain and use endovascular electrograms 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.

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing a first intravascular device having a distal portion with a concave side, inserting the first device into the vascular lumen, positioning the distal portion in the vascular wall, and orienting the concave side of the distal portion toward the vascular lumen.

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 method of clearing a blood clot in a dialysis catheter is provided. The method includes providing a medication reservoir containing clot dissolving medication, an infusion catheter, and an infusion catheter placement guide; accessing an exposed opening of the dialysis catheter; inserting a distal end of the infusion catheter into the exposed opening of the dialysis catheter; advancing the distal end of the infusion catheter through the exposed opening of the dialysis catheter; retracting the infusion catheter back into the dialysis catheter; after determining the location of the distal end of the infusion catheter in relation to the distal end of the dialysis catheter, performing a final adjustment of the location of the distal end of the infusion catheter; and providing medication through the infusion catheter, and out of the distal end of the infusion catheter, to the blood clot to dissolve the blood clot.

An artery can be occluded by implanting an occlusion implant within a subintimal space within a wall of the artery. As an example, a catheter having a side port just proximal of an inflatable balloon disposed near a distal end of the catheter can be advanced through the artery to a site at which an occlusion is desired. The inflatable balloon can be inflated and a guidewire can be advanced through a lumen of the catheter, out of the side port and into a subintimal space of the artery, with the inflated inflatable balloon guiding the guidewire towards the artery wall. An occlusion implant can be advanced over the guidewire into the subintimal space and the guidewire can be withdrawn, leaving the occlusion implant positioned within the subintimal space.

A method of diverting fluid flow from a first vessel including an occlusion to a second vessel includes deploying a prosthesis at least partially in a fistula and making valves in the second vessel incompetent. Making the valves in the second vessel incompetent includes at least one of using a reverse valvulotome to cut the valves, inflating a balloon, expanding a stent, and lining the second vessel with a stent.