The invention discloses a novel vascular punch employing compressive normal force for tissue separation from a targeted vessel. This invention is particularly designed for making a large round hole without massive bleeding in vascular surgery. A clean, non-frayed hole-making guided by the normal force cutting principle is realized using a site-biting punch mechanism. The side-biting vascular punch comprises a U-shaped razor blade cutter, a backstop for receiving the cutter, and a linkage mechanism, forming an aligned line of contact for normal compression force generation and thereby severing tissue out of the targeted vessel.

A medical device and a treatment method, in which energy is accurately applied to a target site by suppressing a positional displacement between an expansion body and a biological tissue. The medical device includes an elongated shaft portion and an expansion body disposed in a distal portion of the shaft portion and configured to expand and contract in a radial direction. The expansion body includes a holding portion having a proximal side holding portion and a distal side holding portion configured to hold the biological tissue, and a movable portion configured to open and close the holding portion.

Devices and methods for exploiting intramural (e.g., subintimal) space of a vascular wall to facilitate the treatment of vascular disease, particularly total occlusions. For example, the devices and methods disclosed herein may be used to visually define the vessel wall boundary, protect the vessel wall boundary from perforation, bypass an occlusion, and/or remove an occlusion.

A method of performing a coronary bypass procedure is performed by a flexible apparatus controlled by at least one controller, the method may include acts of: percutaneously situating the flexible apparatus into a first artery coupled to connective tissue of a chest wall; transluminally detaching at least a portion of the first artery from the connective tissue by applying ultrasound signals of a first type emitted by at least one transducer of the flexible apparatus; steering at least a portion of the detached portion first artery from a current location to a bypass location at a target artery by applying a force transmitted through the flexible apparatus situated within the first artery; and coupling, by the flexible apparatus situated within the first artery, the first artery to the target artery at the bypass location to establish flow communication between the first artery and the target artery.

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes inserting an intramural crossing device into the vascular lumen, positioning at least the distal tip of the crossing device in the vascular wall, advancing an orienting device over the crossing device such that an orienting element of the orienting device resides in the vascular wall, inserting a reentry device, and re-entering the true vascular lumen.

Described here are devices, systems, and methods for improving blood flow in a vessel. Generally, the method may comprise advancing a catheter into a first vessel proximal to an occlusion in the first vessel and forming a fistula between the first vessel and a second vessel. This may deliver blood flow around an occlusion to ischemic tissues located in the peripheral vasculature.

Described here are devices and methods for forming a fistula between two vessels. In some instances, the fistula may be formed between a proximal ulnar artery and a deep ulnar vein. The fistula may be formed using an electrode, and may be formed with a first catheter placed in a first blood vessel and a second catheter placed in a second blood vessel. In some instances, access to the proximal ulnar artery may be achieved through a brachial artery, and access to the deep ulnar vein may be achieved through a brachial vein.

A device for precise control of blood flow across an interatrial septum is provided. The device includes a sheath having a first set of openings disposed within a first atrium while a second set of openings is disposed within a second atrium. An actuator may be actuated to move an inner sleeve within the sheath to modify the area of second set of openings to permit blood to flow between the first and second atria responsive to a pressure gradient across the interatrial septum via the first and second openings at a blood flow rate corresponding with the area of the second set of openings of the sheath. In addition, the patient's hemodynamics responsive to the shunting of blood across the interatrial septum at each incremental area of the opening may be monitored for selecting a specific sized implantable interatrial shunt for the patient.

Systems and methods for implanting an endovascular shunt in a patient is disclosed. The system having an expandable anchor configured for being deployed in a dural venous sinus of a patient at a location distal to a curved portion of a wall of an inferior petrosal sinus (IPS) of the patient; an elongate guide member coupled to, and extending proximally from, the anchor; a shunt delivery catheter having a first lumen configured to receive the guide member, and a second lumen extending between respective proximal and distal openings in the shunt delivery catheter, the shunt delivery catheter further having a penetrating element coupled to a distal end of the catheter; and the system further having a guard at least partially disposed over, and movable relative to, the penetrating element.

A device includes a first end portion, a second end portion, an intermediate portion between the first end portion and the second end portion, and a graft material coupled to at least the intermediate portion. The first end portion has a first end diameter. The second end portion has a second end diameter larger than the first end diameter. The intermediate portion tapers between the first end portion and the second end portion. A method of diverting fluid flow from a first passage to a second passage comprising deploying the device in a third passage between the first passage and the second passage, expanding the first end portion against sidewalls of the first passage, and expanding the second end portion against sidewalls of the second passage.