A system for traversing an arterial occlusion in an artery includes a housing sized to fit in a palm of a user, an elongate drive tube configured to be rotated by the housing, the drive tube including an axially extending passage, a cylindrical member, configured to be rotationally coupled to the drive tube, such that a distal tip of the cylindrical member may be delivered to a location adjacent the arterial occlusion when the cylindrical member is coupled to the drive tube, and wherein grasping and activating the housing such that the drive tube is rotated, thereby causes the distal tip of the cylindrical member to be rotated, the rotation of the distal tip including at least a component of linear oscillation.

The current disclosure generally relates to systems and methods of guidewire control, and in particular to systems and methods for the control of multiple degrees-of-freedom bending and the bending length of a coaxially aligned robotically steerable guidewire. The current disclosure is manually actuated, and in others, is automatically/robotically actuated.

The present invention relates to methods of transvascular retrograde access placement and to devices that facilitate these methods. For purposes of the present invention, transvascular retrograde access placement generally comprises the insertion of a vascular catheter into a central blood vessel through the puncturing of the central blood vessel from the inside of the central blood vessel with a needle or other similarly configured device, or a needle-tipped guidewire of the present invention, and exiting that needle from the patient through the skin rather than the traditional approach of inserting a needle from the outside of the skin surface to the inside of a blood vessel.

An ultrasonic catheter assembly includes a sheath having a sheath lumen. A core wire is at least partially disposed within the sheath lumen. The core wire has a proximal portion and a distal portion. The proximal portion of the core wire is configured to be coupled to an ultrasound-producing mechanism. A working length of the distal portion of the core wire extends distally from the sheath. The working length is configured for longitudinal displacement, transverse displacement, or a combination of longitudinal and transverse displacement, in accordance with a plurality of output modes for vibrational energy supplied to the core wire proximal portion by the ultrasound-producing mechanism.

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.

An intraluminal guide wire may include an elongated shaft extending between a distal and a proximal end. The guide wire may include a user actuation segment positioned proximal to the proximal end of the shaft and configured for movement relative to the shaft. The guide wire may include a core wire affixed to the user actuation segment and the distal end of the shaft. The guide wire may also include an inner member having a proximal end situated at least partially within and fixed relative to the user actuation segment and a distal end situated partially within the shaft, the core wire passing through the inner member. The guide wire may be configured with a distal segment of the inner member within the shaft exhibiting a friction-based restraint on movement within the shaft. The friction-based restraint on movement may be a frictional force between the inner member and the shaft.

A deep vein intravenous introducer has a wheel located toward the front end of the device that can be rotated by the index finger of the user. After placement of the needle in the lumen of the vessel, the user rotates the wheel, which turns a drive wheel. The drive wheel has an outer surface that advances the guide wire through the center of the needle and into the patient. Once the guide wire is advanced into the vessel lumen the catheter can be advanced over the guide wire with a hub or finger tab on the catheter close to the index finger. The operation can be performed by one hand without moving the hand from its initial position.

A drive-enhanceable handheld advancer is provided for advancing an elongate device through a pathway defined in an advancer body that includes a rotatable manual thumbwheel partially embedded in the body for receiving a user-exerted manual control movement from a thumb, and a manual drive having a nip, a transmission, and a reverse clutch. The transmission operatively connects the thumbwheel to the nip for driving advancement, and the reverse clutch maintains a first interference grip connection between the nip and the elongate device. The manual control thumbwheel can move inward responsive to user-applied grip movements to increase grip with the elongate device. The reverse clutch applies augmented force from grip movements to the nip for increasing the grip drive connection, which can be applied at a different angle from the inward movements. The reverse clutch can include slotted pivot supports for the thumbwheel and drive rollers on the advancer body.

Methods and apparatuses for peritoneal catheter placement are disclosed herein. An example method includes using a puncture device to create an access hole to a patient's peritoneal cavity. The puncture device includes a lumen that enables a guidewire to be inserted into the peritoneal cavity. The puncture device is then replaced with a catheter, which is inserted along the guidewire. A surgical seal is next applied to connect the catheter to adjacent patient muscle tissue. After the guidewire is removed, a tunneling device creates a pathway through fat tissue to anchor the catheter. An end of the tunneling device is aligned with an external piercing device to pierce the patient's skin from the outside, creating a catheter exit hole. An end of the catheter is connected to the tunneling device and pulled through the exit hole, thereby enabling the catheter to be connected to peritoneal dialysis tubing for a treatment.

A wire delivery device for delivering a wire includes a rod, a gear, a first roller, and a second roller. The rod has an elongated external shape and a first surface with concave portions and convex portions arranged along a longitudinal direction of the rod, the rod being configured to move in a distal end direction of the wire delivery device. The gear is configured to engage the concave portions and convex portions and rotate in response to movement of the rod in the distal end direction. The first roller and the second roller are configured to sandwich the wire and rotate in response to rotation of the gear to deliver the wire in the distal end direction.