A launching catheter for targeting a second vessel from a first vessel includes a catheter including a proximal portion and a distal portion including a needle aperture and a flat rectangular radiopaque marker. The flat rectangular radiopaque marker disappears under fluoroscopy upon rotation to provide information about rotational alignment of the launching catheter. The launching catheter includes a needle configured to extend through the needle aperture. A method of aligning the catheter includes rotating the catheter in a first blood vessel until the marker has a thickness (e.g., minimal thickness) under fluoroscopy. The thickness indicates rotational alignment of the catheter.

A subcutaneous tunneling device includes a shaft having a bend, a catheter connector extending from a distal end of the shaft distal of the bend, and a sleeve. The catheter connector can include a body having a gripping portion, and a barbed extension distal of the body configured for insertion into a lumen of a catheter. The sleeve is slidably mounted on the shaft, and has a retracted position exposing the catheter connector to permit a distal end of a catheter to be coupled thereto, and an extended position covering the catheter connector and the distal end of the catheter.

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 a P-wave segment in an endovascular ECG signal associated with the indwelling medical device, then calculating a positive energy value relating to an amount of energy of the P-wave segment above a baseline of the endovascular ECG signal and a negative energy value relating to an amount of energy of the P-wave segment below a baseline of the endovascular ECG signal. A position of the medical device within the vasculature can be determined using at least one of the positive energy value and the negative energy value in a graphical user interface.

A tunnel device includes a base portion, a shaft to be connected to the base portion at one end of the shaft, and a tip portion to be connected to another end of shaft. The base portion is provided with a shaft connection portion to which the one end of shaft is connected. The shaft is provided with a shaft-side screw portion at the one end of the shaft. The shaft connection portion includes a shaft housing portion having an inner diameter substantially same as an outer diameter of the one end of the shaft, and a base-portion side screw portion provided on a further inner side relative to the shaft housing portion. The base portion and the shaft are fixed to each other by screwing between the shaft-side screw portion and the base-portion side screw portion.

Establishing connections across tissue walls used to create shunts or similar passageways are formed using methods and devices that utilize magnets for navigation and location of devices on opposite sides of the walls. Various tools are provided that optimize the uses provided by the magnets.

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 balloon catheter including a catheter shaft and an inflatable balloon secured to a distal end region of the catheter shaft. The inflatable balloon has a generally conical shape in a fully inflated configuration having a proximal conical portion that tapers away from the central longitudinal axis in a distal direction from a proximal waist of the balloon and a distal conical portion that tapers toward the central longitudinal axis in a distal direction toward a distal waist of the balloon, with a radially outermost extent of the balloon located between the proximal conical portion and the distal conical portion. The proximal conical portion, the distal conical portion and/or the radially outermost extent of the balloon has an elliptical cross-section taken in a plane perpendicular to the central longitudinal axis of the catheter shaft.

A reentry catheter for crossing a vascular occlusion includes an elongate flexible tubular body, having a proximal end, a distal end and at least one lumen extending there through. A reentry zone on the tubular body includes at least two and preferably three sets of opposing pairs of axially spaced exit apertures in communication with the lumen. The apertures are rotationally offset from each other and aligned in a spiral pattern around the tubular body. A method of crossing a chronic total occlusion includes the steps of advancing the reentry catheter across the occlusion via a channel formed in the subintimal space, and advancing a guidewire via a selected exit port into the native lumen distally of the occlusion. The catheter may be removed, leaving the guidewire across the occlusion to guide further interventional devices.

Intravascular catheters with fluoroscopically visible indicium of rotational orientation. The catheter includes an elongate flexible tubular body, having a proximal end, a distal end and a tubular side wall defining at least one lumen extending therethrough. At least first and second opposing pairs of radiopaque rings are embedded in the side wall, spaced axially apart from each other. A first transverse axis extending through the first pair of rings is rotationally offset from a second transverse axis extending through the second pair of rings. The rings may be supported by a subassembly integrated into the wall of the catheter. The subassembly may include a tubular body having a plurality of aperture portions connected by intervening hinge portions. In one implementation, the catheter is a reentry catheter.

A launching catheter for targeting a second vessel from a first vessel includes a catheter including a proximal portion and a distal portion including a needle aperture and a flat rectangular radiopaque marker. The flat rectangular radiopaque marker disappears under fluoroscopy upon rotation to provide information about rotational alignment of the launching catheter. The launching catheter includes a needle configured to extend through the needle aperture. A method of aligning the catheter includes rotating the catheter in a first blood vessel until the marker has a thickness (e.g., minimal thickness) under fluoroscopy. The thickness indicates rotational alignment of the catheter.