The present disclosure provides methods and apparatuses for guiding an endovascular tool, such as a puncturing tool or an angioscope, in a radial direction, such as toward or through the sidewall of a vessel, stent, or stent graft, using elongate members and specialized catheters. The present disclosure provides methods and apparatuses for locating branch vessels from within a grafted main vessel while maintaining continuous blood flow to the branch vessel. Another aspect of the present disclosure involves a reverse cannulation system, particularly useful for stenting the abdominal aorta proximate the renal arteries and stenting the renal artery.

The disclosure relates to medical devices comprising coaxial cannulae. A medical device includes an outer cannula and a coaxial inner cannula that is secure to the inner cannula. The circumferential wall of one of the cannulae defines a pattern of openings that extends along a spiral path about the lengthwise axis of the cannula.

Tortuosity of vessels at or leading to the site of minimally invasive procedures is a problem for conducting such procedures as they increase the difficulty to guide the procedural catheters through tortuous vessels. Methods and apparatus for stabilization of the sheaths and catheters during access, procedures, and withdrawal in these tortuous vessels are disclosed. The apparatus and method for improving access include application of a pull component to the stabilized procedural catheter using a stabilization catheter/wire in addition to a push component from the percutaneous access to make the access easier while enabling use of more flexible catheters and softer wires. These methods and devices address the problems of trauma to the vessels during access, procedure and removal of catheters and wires, improve pushability of softer catheters and wires, and also substantially reduce substantially the procedure time.

A catheter apparatus may have a flexible shaft, guidewire lumens passing through the shaft, and a positioning device for positioning the guidewires relative to an external lumen. The positioning device may be an expansible scaffold covered with a retractable sheath. The positioning device may also be one or more balloons that are inflated through an inflation port in the shaft. The catheter apparatus may be operated by inserting a guide catheter into a vasculature with a chronic total occlusion, inserting the catheter apparatus into the guide catheter, and advancing the guidewires through the guidewire lumens and into contact with a chronic total occlusion. The positioning device may be activated before and/or between attempts to pass the guidewires through the chronic total occlusion to interrogate various parts of the chronic total occlusion.

A catheter includes a tubular inner layer, a reinforcing layer disposed at least partially within the inner layer or on an outer circumference of the inner layer, and an outer layer. The reinforcing member is made of wound wires, each adjacent pair of the wires having a gap therebetween. A bonding portion is disposed in the gap of the reinforcing layer and includes an inner layer protruding portion of the inner layer that extends into the outer layer and is engaged with an outer layer protruding portion of the outer layer that extends into the inner layer. This configuration enlarges the area across which the outer layer and the inner layer are bonded to each other within the gap of the reinforcing layer, leading to a strengthened bond between the outer layer and the inner layer.

The drainage catheter according to the examples of the present invention comprises a first induction conduit; and a second induction conduit having a circumference part surrounding the first induction conduit, in which a cut part is formed so that a front edge of the first induction conduit is exposed to the outside.

Disclosed herein are proximally-flaring stents and balloon catheter systems and methods for using the same to restore patency to a side branch and its ostium at a vessel bifurcation, where the side branch can only be approached from the direction of the main artery. The system and methods include a proximally-flaring stent and one or more balloon catheters with inflatable balloons that are able to push a flanged proximal portion of the proximally-flaring stent entirely against the artery walls of the main artery of the side branch so that blood flow is not occluded.

A cannulation device is adapted to gain access to the patient's common bile duct. In some instances, the cannulation device includes a first guidewire lumen extending through an elongate shaft and terminating at a first oblique guidewire port, and a second guidewire lumen extending through the elongate shaft and terminating at a second oblique guidewire port. In some instances, the cannulation device includes an inflatable balloon that is inflatable from a collapsed configuration to an expanded configuration in which the inflatable balloon is adapted to occlude the patient's pancreatic duct. In some instances, the cannulation device includes an expandable element that is expandable from a collapsed configuration in which the expandable element is disposed within the guidewire lumen and an extended configuration in which a portion of the expandable element extends distally from a guidewire port.

An improved balloon catheter structure includes a beveled distal tip, a reinforced distal portion, and an elastic or split sleeve over at least a portion of the balloon. The balloon may have a short length and a marker at its midline. The catheters are particularly useful for crossing through stent walls at vessel bifurcations.

Tortuosity of vessels at or leading to the site of minimally invasive procedures is a problem for conducting such procedures as they increase the difficulty to guide the procedural catheters through tortuous vessels. Methods and apparatus for stabilization of the sheaths and catheters during access, procedures, and withdrawal in these tortuous vessels are disclosed. The apparatus and method for improving access include application of a pull component to the stabilized procedural catheter using a stabilization catheter/wire in addition to a push component from the percutaneous access to make the access easier while enabling use of more flexible catheters and softer wires. These methods and devices address the problems of trauma to the vessels during access, procedure and removal of catheters and wires, improve pushability of softer catheters and wires, and also substantially reduce substantially the procedure time.