Some of the present methods include, and some embodiments of the present systems are configured for gaining access to a patient's vessel by way of the vessel (i.e. from the inside out). Some embodiments facilitate gaining access to an occluded vessel, where part of the access path is through the occlusion.

A catheter for delivering fluids includes a hollow tube having a proximal section, a distal section, and an elongated lumen that extends through the proximal and distal sections of the hollow tube. One or more fluid openings are formed in the distal section of the hollow tube, which are in fluid communication with the elongated lumen of the hollow tube. A visible marker collar is secured to an outer surface of the hollow tube and is located at a junction of the proximal and distal sections of the hollow tube. A visible marker filament is disposed within the elongated lumen of the hollow tube and extends between the junction of the proximal and distal sections of the hollow tube and a distal end of the hollow tube. The visible markers are used to identify a soaker region of the catheter used to infuse fluids or drain fluids from a patient.

Methods, devices, and kits for implanting a vascular graft to perform hemodialysis treatments on patients with renal failure are disclosed. The kits can include access devices comprised of an access catheter having a guidewire lumen and stylet lumen, a guide tube having a curved distal end, a stylet, an actuator handle and a vascular graft. The methods describe techniques for using the described kits and devices for performing vascular procedures, such as percutaneous implantation of the vascular graft.

Some embodiments of an electrical stimulation system employ wireless electrode assemblies to provide pacing therapy, defibrillation therapy, or other stimulation therapy. In certain embodiments, the wireless electrode assemblies may include a guide wire channel so that each electrode assembly can be advanced over a guide wire instrument through the endocardium. For example, a distal tip portion of a guide wire instrument can penetrate through the endocardium and into the myocardial wall of a heart chamber, and the electrode assembly may then be advanced over the guide wire and into the heart chamber wall. In such circumstances, the guide wire instrument (and other portions of the delivery system) can be retracted from the heart chamber wall, thereby leaving the electrode assembly embedded in the heart tissue.

Systems, devices, and methods are provided for transseptal access of septa within a patient. The device can be advanced to a septum, e.g., towards a fossa ovalis. Instead of applying positive pressure to “tent” the septum, a negative pressure is applied to a lumen within a sheath, e.g., within an elongated member slidable within the sheath, via a negative pressure source such as a syringe on the proximal end of the sheath. This results in the septum pulling inward. The sheath employs a stationary needle-like central core component contained within the lumen of the sheath that punctures the septum when the same is pulled passed it by the negative pressure. The stationary needle-like central core component may be hollow and may form a portion of the elongated member or may be coupled to a distal end thereof.

A method is provided including inserting a catheter into a right atrium and advancing a distal portion of the catheter toward a roof of the right atrium. A flexible longitudinal member is deployed from the catheter, such that a deployed portion of the flexible longitudinal member is loop-shaped. The deployed portion of the flexible longitudinal member is brought into contact with a single stabilization site located on the roof of the right atrium, between the roof and an interatrial septum, or on the interatrial septum superior to a fossa ovalis. A needle is deployed from the catheter and brought in contact with a hole site on a surface of the interatrial septum outside the fossa ovalis. A hole is formed through the interatrial septum at the hole site with the needle. The deployed portion of the flexible longitudinal member is withdrawn toward the catheter. Other embodiments are also described.

A needle-tract assistants (100, 200) for establishing a needle tract of a predetermined length, including a needle thruster (110, 210) and a needle-in-catheter assembly (130, 230) removably loaded in the needle thruster (110, 210). The needle thruster (110, 210) can include a cradle (112, 212), a carriage(114, 214) within the cradle (112, 212), and a plunger (116, 216) coupled to the carriages (114, 214). The carriages (114, 214) can be configured to move between a proximal-end portion and a distal-end portion of the cradle(112, 212). The plungers (116, 216) can be configured to move the carriages (114, 214) within the cradle(112, 212). The plungers (116, 216) can also be configured to allow a user to set the predetermined length of the needle tract before establishing the needle tract. The needle-in-catheter assembly (130, 230) can include a hub (132, 232), a catheter tube (134, 234) extending from a distal-end portion of the hub (132, 232), and a needle (137, 237) disposed within the catheter tube (134, 234). Also described are components of the needle-tract assistants (100, 200) and methods of the needle-tract assistants (100, 200) or the components thereof.

Tissue puncture devices, and systems and methods for accessing tissue (e.g., cardiovascular tissue) according to the present disclosure may include a tubular sheath extending along a longitudinal axis, the tubular sheath having a proximal end and a distal end, a needle disposed coaxially in the sheath, the needle having a proximal end and a distal end and being movable along the longitudinal axis of sheath, and a needle control mechanism disposed at the proximal end of the needle, the needle control mechanism being configured to lock the distal end of the needle in a first position retracted within the distal end of the sheath, and release the needle to an unlocked second position such that the distal end of the needle is extendable beyond the distal end of the sheath.

Mitral valve prolapse and mitral regurgitation can be treating by implanting in the mitral annulus a transvalvular intraannular band. The band has a first end, a first anchoring portion located proximate the first end, a second end, a second anchoring portion located proximate the second end, and a central portion. The central portion is positioned so that it extends transversely across a coaptive edge formed by the closure of the mitral valve leaflets. The band may be implanted via translumenal access or via thoracotomy.

An intravascular catheter for nerve activity ablation and/or sensing includes one or more needles advanced through supported guide tubes (needle guiding elements) which expand to contact the interior surface of the wall of the renal artery or other vessel of a human body allowing the needles to be advanced though the vessel wall into the extra-luminal tissue including the media, adventitia and periadvential space. The catheter also includes structures which provide radial and lateral support to the guide tubes so that the guide tubes open uniformly and maintain their position against the interior surface of the vessel wall as the sharpened needles are advanced to penetrate into the vessel wall. Electrodes near the distal ends of the needles allow sensing of nerve activity before and after attempted renal denervation. In a combination embodiment ablative energy or fluid is delivered from the needles in or near the adventitia to ablate nerves outside of the media while sparing nerves within the media.