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 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.

An apparatus is provided for subcutaneous implantation in a patient using a tunneling instrument. The implantation apparatus comprises a vascular graft and a connector adapted to couple a distal end of the tunneling instrument and a proximal end of the graft. The connector comprises a tip, a first end of the tip configured to be received within the proximal end of the graft, a clip for securing the graft to the tip, and a coupler for a rotatable connection of the tip to the tunneling instrument such that the tip is rotatable about its longitudinal axis relative to the coupler to facilitate attachment of the graft to the tunneling instrument. The implantation apparatus may further comprise a removable sheath configured to substantially cover the length of the graft.

Embodiments disclosed herein are directed to a catheter placement system including a dual lumen catheter, or similar device, and a catheter stiffening system configured to facilitate placement of the catheter. The catheter stiffening system can include a first stylet disposed in a first catheter lumen and a second stylet disposed in a second catheter lumen. A guidewire can extend through a stylet lumen of the second stylet and a channel of the first stylet. A distal portion of the first stylet can include a skived portion and a distal portion of the second stylet can include a notched portion. As such, the distal portions of the first stylet and the second stylet can interlock and align the stylet lumen with the channel. The guidewire can extend through both the stylet lumen and the channel to further secure the distal portions of the stylets together.

Compositions and methods are described for the delivery of a fully human post-translationally modified (HuPTM) monoclonal antibody (mAb) or the antigen-binding fragment of a mAb against human vascular endothelial growth factor (hVEGF)such as, e.g., a fully human-glycosylated (HuGly) anti-hVEGF antigen-binding fragmentto the retina/vitreal humour in the eye(s) of human subjects diagnosed with ocular diseases caused by increased neovascularization, for example, neovascular age-related macular degeneration (nAMD), also known as wet age-related macular degeneration (WAMD), age-related macular degeneration (AMD), and diabetic retinopathy.

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.

Embodiments disclosed herein are directed to a universal tunneler (100) including a shaft (110) and a hub. The hub (130) includes an H-shaped grip piece (140) configured to engage an end portion of the shaft and further includes a sheath (152) slidably engaged therewith. Sliding the sheath longitudinally causes the gripping arms (146A, 146B) to deflect radially inwards and grip a tip portion of the catheter (28) disposed therebetween. The tunneler can then be urged through a subcutaneous tunnel pulling the catheter therewith. Advantageously, the hub does not require the catheter tip to include any specialized engagement structures. Further, the hub grips and encloses the tip structures mitigating any damage during the tunneling process. The HI-shaped grip portion provides a simplified structure for case of manufacture and reducing costs.

A catheter for facilitating re-entry of a re-entry wire into a true lumen or into any desired region of a blood vessel may have an elongate shaft with a first lumen. A distal port and a first proximal port are fluidly coupled with the first lumen. A wire re-entry port is adjacent the distal end of the elongate shaft. The wire re-entry port has a re-entry axis. An ultrasound transducer on the catheter is configured to produce an image the blood vessel, and has a central axis that allows visualization of the re-entry wire as it exits the re-entry port and re-enters the true lumen. This allows the operator to ensure that the re-entry wire re-enters the true lumen in a desired location and does not damage the vessel.

An external end device has a casing, including a base, in which a distal opening is formed which receives a funnel-shaped septum having a tube trunk. Inside the tube trunk, the catheter is connected to the distal section of the fitting. A tubular coating has a proximal end adapted to be grafted onto the tube trunk and a distal end coaxially adhering to the catheter. A pair of bands of tissue-ingrowth material is fixed on the tubular coating, and an anchor ring, equipped with anchoring means, is sandwiched between the bands.

In some examples, a tool for, e.g., creating a sub-sternal tunnel in a patient or other use, is described. The tool may include a handle and a tunneling shaft coupled to the handle. The tunneling shaft extends from a proximal end to a distal end, and at least a portion of the tunneling shaft extends in a curved orientation between the first end to the distal end. The distal end of the tunneling shaft includes a cutting tool having a sharp edge. The cutting tool is moveable from a recessed position in which the sharp edge of the cutting tool is recessed into the distal end of the tunneling shaft to a deployed position in which the sharp edge of the cutting tool extends beyond the distal end of the tunneling shaft in the deployed position, e.g., to cut pericardium, scar tissue, and/or connective tissue with the sharp edge.