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.

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.

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.

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.

In one embodiment, a system includes a small-diameter tube having an elongated body, a distal tip, and an inner lumen that extends the length of the tube, the distal tip including a magnetic element that generates a strong focal magnetic field, and a crossing wire having an elongated body and a distal tip, the distal tip of the crossing wire including a ferromagnetic element that is magnetically attracted to the distal tip of the small-diameter tube when the distal tip of the crossing wire is placed in proximity to the distal tip of the small-diameter tube so as to facilitate alignment of the distal tips.

The invention generally relates to method and apparatus for crossing an obstruction in a tubular member, and more particularly to a medical device method for crossing of a chronic occlusion in a subintimal or interstitial space of an artery.

Embodiments of the present disclosure provide a medical device for snaring guidewire during endovascular procedure. The medical device includes a catheter and an elongate member. The catheter is deployed into a lumen of a blood vessel through a first vascular access point of a subject. The elongate member includes a distal tip mounted with a first magnetic element and configured to be insertable within the catheter. The elongate member is deployed in the lumen of the blood vessel by advancing through the catheter. The first magnetic element of the elongate member is configured to exert magnetic force to magnetically couple with a guidewire advancing within the lumen through a second vascular access point. The magnetic coupling of the elongate member and the guidewire facilitates attracting the guidewire into the catheter and draw out from the first vascular access point by withdrawing the elongate member while advancing the guidewire.

Embodiments of the invention are directed towards a rapid exchange catheter configured for insertion into a subintimal space and crossing an occlusion in a subintimal space. The catheter includes a proximal end, a distal end, a first lumen configured to receive a first wire, the first lumen extending longitudinally through a least a lateral port of the catheter, and a second lumen having at least a portion distal of the lateral port and extending through at least the distal end of the catheter. The catheter also includes an exchange port arranged on a exterior portion of the catheter configured to the receive a second wire and second rapid exchange port in communication with the second lumen. Moreover, other embodiments of the invention are directed towards methods for using the rapid exchange catheter to cross an obstruction in a vessel, e.g., a total or partial occlusion, in a subintimal space.

A biologics delivery device and method of use for promoting angiogenesis in occluded vessels and ischemic tissue of a patient are provided, wherein the biologics delivery device includes a catheter having a proximal end, a distal region having a distal end, and a side wall defining a catheter lumen; an expandable member disposed in the distal region, the expandable member configured to support a subintimal space in an occluded blood vessel of a patient, and to transition between a collapsed state and an expanded state; and a hollow needle having a penetration tip deployable from inside the catheter lumen to outside the catheter lumen, and into tissue surrounding the occluded blood vessel, wherein the expandable member in the expanded state allows the flow of oxygenated blood to the occluded blood vessel. Methods of using the inventive biologics delivery device also are provided to deposit the biologic from a subintimal space to tissue surrounding the occluded blood vessel.

A biologics delivery device and method of use for promoting angiogenesis in occluded vessels and ischemic tissue of a patient are provided, wherein the biologics delivery device includes a catheter having a proximal end, a distal region having a distal end, a lumen extending there between, and a plurality of through-wall apertures distributed along the distal region, the plurality of through-wall apertures in fluid communication with the proximal end and the lumen, and an expandable member disposed in the distal region, the expandable member configured to transition between a collapsed state and an expanded state. Methods of using the inventive biologics delivery device also are provided to achieve substantially uniform distribution of the biologic into a subintimal space.