Transvascular access methods

Abstract

Various methods employing transvascular access devices are described, including a method of placing a central catheter in a peripheral vein in an arm of a patient; a method of providing percutaneous access to the heart of a patient; a method of clearing a clotted arteriovenous dialysis graft; a method of creating multiple access points into a single blood vessel; a method of creating an AV fistula in a patient; and a method of providing a bypass to a blockage in a popliteal artery in a patient.

1 . (canceled) 
     
     
         2 . A method of clearing a clotted arteriovenous dialysis graft, the method comprising:
 inserting an access device into the graft at a first access point, the access device comprising a vascular catheter;   advancing a distal end of the vascular catheter from the first access point through the graft to a second access point in the graft;   advancing a puncture tool from the distal end of the catheter through a graft wall of the graft at the second access point; and   inserting a clot clearing device into the graft at the second access point.   
     
     
         3 . The method of  claim 2 , wherein the first access point is above an arterial anastomosis. 
     
     
         4 . The method of  claim 2 , wherein the second access point is in front of a venous anastomosis. 
     
     
         5 . The method of  claim 3 , wherein the arterial anastomosis is in a brachial artery. 
     
     
         6 . The method of  claim 4 , wherein the venous anastomosis is in an axillary vein. 
     
     
         7 . The method of  claim 2 , further comprising declotting the graft with the clot clearing device. 
     
     
         8 . The method of  claim 2 , wherein the clot clearing device is a suction-aspiration device. 
     
     
         9 . The method of  claim 6 , further comprising declotting the axillary vein and the venous anastomosis. 
     
     
         10 . The method of  claim 2 , wherein puncture tool extends through the graft wall and skin of a patient at the second access point. 
     
     
         11 . The method of  claim 2 , further comprising performing a balloon angioplasty of the venous anastomosis. 
     
     
         12 . A method of clearing a clotted arteriovenous dialysis graft, the method comprising:
 inserting a vascular catheter into the graft at a first access point;   advancing a puncture tool from the distal end of the catheter through a graft wall of the graft at the second access point; and   inserting a clot clearing device into the graft at the second access point.   
     
     
         13 . The method of  claim 12 , wherein the first access point is above an arterial anastomosis. 
     
     
         14 . The method of  claim 12 , wherein the second access point is in front of a venous anastomosis. 
     
     
         15 . The method of  claim 12 , further comprising declotting the graft with the clot clearing device. 
     
     
         16 . The method of  claim 12 , wherein the clot clearing device is a suction-aspiration device. 
     
     
         17 . The method of  claim 12 , wherein puncture tool extends through the graft wall and skin of a patient at the second access point. 
     
     
         18 . A method of clearing a clotted arteriovenous dialysis graft, the method comprising:
 inserting a vascular catheter into the graft at a first access point;   advancing a puncture tool along the catheter to a distal end of the catheter;   advancing the puncture tool from the distal end of the catheter through the graft wall and the skin of a patient at a second access point; and   inserting a clot clearing device into the graft at the second access point.   
     
     
         19 . The method of  claim 18 , wherein the first access point is above an arterial anastomosis. 
     
     
         20 . The method of  claim 18 , wherein the second access point is in front of a venous anastomosis. 
     
     
         21 . The method of  claim 18 , further comprising performing a balloon angioplasty of the venous anastomosis.