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 providing an intravascular device having a distal portion with a side port, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall, directing the distal portion within the vascular wall such that the distal portion moves at least partially laterally, and directing the side port towards the vascular lumen.

A wire for use with a vascular treatment device may have a proximal end, a distal end, and a main shaft extending therebetween. The distal end may have a distal free end and a first segment. The first segment may extend from the main shaft and may be biased to a first included angle that is defined between the main shaft and the first segment and less than 180 degrees.

A method of treating a vessel in a subject comprises the steps of advancing a device distally across a treatment zone in a vessel, wherein the device comprises an elongated catheter having a lumen and a distal end, and a radially expansive treatment element disposed in the lumen and configured for axial movement relative to the catheter; deploying the radially expansive treatment element proud of the distal end of the catheter to radially expand and circumferentially impress against the vessel lumen at a distal end of the treatment zone; and withdrawing the deployed radially expansive treatment element proximally along the treatment zone with the treatment element circumferentially impressed against the vessel lumen to mechanically and circumferentially denude the treatment zone of the vessel. The radially expansive treatment element is then recaptured into the lumen of the catheter, before the device is withdrawn from the treated vessel.

The disclosure includes a controller and a sheath having an open proximal sheath end coupled to the controller, an open distal sheath end configured for insertion into a vascular system of a patient, and a working lumen extending through the sheath. The system may include a wire extending from the controller through the working lumen, the wire having a distal wire end configured to mechanically treat a vessel wall of a treatment segment, a length of the distal wire end defining a length of the treatment segment. The working lumen may be configured to slidably receive the wire and allow for a passage of a fluid about the wire therethrough to chemically treat the treatment segment. When the system receives a first input the distal wire end may mechanically treat the vessel wall. When the system receives a second input and/or a third input, the system may deliver the fluid.

A dissecting device for dissecting tissue surrounding a blood vessel in a living body. The dissecting device includes a grasping section that includes an insertion lumen. The dissecting device includes a dissecting member at the distal portion of the grasping section. The dissecting member is insertable into the living body along the blood vessel to dissect the tissue surrounding the blood vessel in the living body. The dissecting member includes a treating section and a protruding section. The treating section performs a predetermined treatment of a branch vessel branching from the blood vessel. The protruding section protrudes from the treating section in the thickness direction of the treating section. The protruding section includes a guide section configured to guide the branch vessel toward the treating section.

A dissecting device that includes a grasping section and a dissecting member. The grasping section has an insertion lumen that permits an imaging device to be positioned therein. The dissecting member is at the distal portion of the grasping section and is insertable into a living body and movable along a blood vessel to dissect tissue surrounding the blood vessel. The dissecting member includes a base part having a lumen that communicates with the insertion lumen and a dissecting section which extends distally from the base part. The dissecting section is configured to dissect the tissue in the living body when the dissecting member is moved along the blood vessel. The dissecting member includes a blood vessel guide passage that accepts a branch vessel branched from the blood vessel at the distal portion of the dissecting member and guides the branch vessel toward the base part.

A method of treating a vessel in a subject comprises the steps of advancing a device distally across a treatment zone in a vessel, wherein the device comprises an elongated catheter having a lumen and a distal end, and a radially expansive treatment element disposed in the lumen and configured for axial movement relative to the catheter; deploying the radially expansive treatment element proud of the distal end of the catheter to radially expand and circumferentially impress against the vessel lumen at a distal end of the treatment zone; and withdrawing the deployed radially expansive treatment element proximally along the treatment zone with the treatment element circumferentially impressed against the vessel lumen to mechanically and circumferentially denude the treatment zone of the vessel. The radially expansive treatment element is then recaptured into the lumen of the catheter, before the device is withdrawn from the treated vessel.

Unitary endoscopic vessel harvesting devices are disclosed. In some embodiments, such devices comprise an elongated body having a proximal end and a distal end; an inflatable, coated or conditioned tip disposed at the distal end of the elongated body; and a cutting unit having a first cutting portion and a second cutting portion, the first cutting portion and the second cutting portion being moveable in a longitudinal direction relative to the elongated body to capture a blood vessel between the first cutting portion and the second cutting portion, and being rotatable relative to one another circumferentially about the tip to cut the captured blood vessel.

A therapeutic foam for the treatment of, inter alia, varicose veins comprises a sclerosing solution foamed with a physiological gas such as carbon dioxide, oxygen or a mixture thereof. The foam has a nitrogen content of less than 0.8%. It may be generated using a pressurized canister system incorporating a fine mesh of micron dimensions through which the gas and sclerosing liquid are passed to make the foam. Alternatively, the foam may be generated by passing gas and solution between two syringes through a fine mesh. Techniques are described for minimizing the amount of nitrogen in a canister or syringe based product. A technique for generating and delivering foam simultaneously using a syringe based device is also disclosed.

A blood vessel dissecting device includes: a dissecting device which, when inserted into a living body along a blood vessel, dissects tissue in a direction of alignment of the dissecting device with the blood vessel; and a cutting device which, when inserted into the living body along the blood vessel, cuts tissue surrounding the blood vessel in a direction of alignment of the cutting device with the blood vessel. A blood vessel dissecting method includes: inserting a dissecting device into a living body along a blood vessel so as to dissect tissue in a direction of alignment of the dissecting device with the blood vessel; and inserting a cutting device into the living body along the blood vessel while guiding the cutting device with the dissecting device so as to cut tissue surrounding the blood vessel in a direction of alignment of the cutting device with the blood vessel.