Methods and devices for trans-jugular carotid access are disclosed. Methods within the scope of this disclosure include methods of trans-jugular carotid access originating in the leg of a patient or other location remote to the jugular vein and carotid artery and methods originating at the neck of a patient. Devices used in connection with the disclosed methods may comprise access catheters, lumens, and stylets.

In a multiple-lumen catheter having multiple guidewires for treatment of vascular blockages, the catheter comprising a proximal-end assembly, a distal-end portion and a multi-lumen medial portion therebetween, the improvement wherein: (1) the multiple guidewires are preloaded in the catheter, each guidewire in its own single-guidewire lumen extending from its own guidewire entry port in the proximal-end assembly to a lumen convergence portion; and (2) the distal-end portion includes: (a) the lumen convergence portion along which the multiple lumens merge into a single output lumen sized to match the largest-diameter lumen of the multiple lumens, (b) an intermediate distal-end section connected to the lumen convergence portion and surrounding the single output lumen continuing therethrough, and (c) a tapered tip surrounding the single output lumen continuing therethrough.

A delivery system includes a handle, a guidewire catheter, a nose cone at the distal end of the guidewire catheter that with the guidewire catheter defines an opening concentric with the guidewire catheter, a plurality of wires that extend distally from the handle and essentially parallel with and distributed radially about the guidewire catheter and a stent graft. The wires each extend between a portion of the stents and wall of the stent graft, whereby the stent graft is radially constrained until the wires are retracted. The delivery system can be employed in methods of treating arterial disease, such as aortic aneurysms.

A system for creating an arteriovenous (AV) fistula comprises a vessel access sheath having a hollow interior and an exit port, a side access needle catheter configured to fit within the hollow interior of the sheath, a needle configured to be inserted into a blood vessel through the side access needle catheter, a toggle delivery catheter configured to fit within the hollow interior of the sheath, and a toggle apparatus configured to be delivered into a vessel through the toggle delivery catheter. The toggle apparatus comprises a shaft and a toggle member pivotably attached to a distal end of the shaft. A source of RF energy or resistive heat energy may be provided for application to the toggle member and/or to a heater insert in the toggle delivery catheter, for the purpose of creating the fistula.

An instrument advancement device may include a housing, which may include a slot. The instrument advancement device may be configured to couple to a catheter assembly. The instrument advancement device may include an advancement element, which may extend through the slot and may be configured to move linearly along the slot between a retracted position and an advanced position. In response to movement of the advancement element from a retracted position to an advanced position, an instrument of the instrument advancement device may be advanced beyond a distal end of the housing and may be configured to open a path through an occlusion in the catheter assembly or vasculature. The instrument advancement device may include a septum that includes a shape and/or a lube to reduce septum resistance and buckling of the instrument during advancement of the instrument.

A vascular access device may include a housing, which may include a distal end, a proximal end, and a slot. An advancement element may extend through the slot and may be configured to move linearly along the slot between a retracted position and an advanced position. In response to movement of the advancement element from the retracted position to the advanced position, a probe of the vascular access device may be advanced beyond the distal end. The vascular access device may include one or more features to reduce buckling of the probe and limit displacement of the probe. For example, the vascular access device may include a protrusion fixed within the housing distal to the advancement element. As another example, the vascular access device may include a distally-extending arm and/or a recess configured to receive the distally extending arm.

An instrument advancement device may include a housing, which may include a distal end and a proximal end. An instrument, such as a vascular access instrument configured to enter vasculature of a patient, may be disposed within the housing. The instrument advancement device may include an advancement element. In response to movement of the advancement element with respect to the housing, the instrument may be configured to advance distal to the distal end of the housing. The housing or a distal end of the housing may include a compressible portion proximate a chamber configured to hold blood. In response to compression of the compressible portion, the housing may be configured to dispense blood distally from the chamber through the distal end of the housing.

An instrument delivery device may include a housing, which may include a proximal end, a distal end, and a slot. The instrument delivery device may include an advancement element extending through the slot and configured to move linearly along the slot. The instrument delivery device may include a guidewire, which may include a first end and a second end. In response to movement of the advancement element distally a first distance along the slot, the second end of the guidewire may be configured to advance a second distance. The second distance may be at least twice the first distance. The instrument delivery device may include a tubing, which may include a distal end and a proximal end. In response to movement of the advancement element distally the first distance along the slot, the proximal end of the tubing may be configured to advance the first distance.

A catheter assembly may include an adapter having a distal end, a proximal end, a side port, and an adapter lumen. The catheter assembly may include a catheter hub, which may include a distal end, a proximal end, a catheter hub lumen, and another side port. The catheter assembly may include an extension tube. A distal end of the extension tube may be coupled to the other side port, and the distal end of the adapter may be coupled to a proximal end of the extension tube. A fluidic seal may be formed around a tube of an instrument advancement device when the tube is advanced into the adapter. As an example, a portion of the adapter lumen between the distal end of the adapter and the side port may include an annular protrusion configured to form the fluidic seal.

A vascular access device may include an advancement element and a housing. The housing may include a lumen extending therethrough, which may be used for blood collection. The vascular access device may include a pair of opposing pinch members configured to pinch the housing. The pair of opposing pinch members may be configured to move along the housing with the advancement element. The vascular access device may include a guidewire, which may include a wedge. In response to moving the advancement element distally along the housing, the pair of opposing pinch members may move the wedge distally and the guidewire may be advanced distally. The proximal end of the guidewire may include a looped portion, and in response to moving the advancement element distally along the housing, the pair of opposing pinch members may be aligned with an opening formed by the looped portion and advance the guidewire distally.