Abstract: Systems and methods for positioning a wire for advancement through a vessel wall, and advancing it through one or more vessel walls, generally include a delivery catheter and an alignment catheter or a receiving catheter, and a guidewire. In some variations, the systems and methods may be used to bypass an occlusion or other barrier that may prevent advancement of a wire or tools through an endoluminal space. In these variations, the systems and methods include a delivery catheter, a bypass catheter, a receiving catheter, and a guidewire. The delivery and receiving catheters each generally include a side aperture, a deflection surface, and an alignment element, and the bypass catheter generally includes two side apertures, two deflectors, and two alignment elements. In some variations, the systems and methods may assist in treatment of a patient suffering from critical limb ischemia.

Abstract: Described here are devices, systems, and methods for adhering tubular structures, such as blood vessels. Generally, the methods may comprise advancing a first catheter comprising a first adhesion element into a first blood vessel and a second catheter comprising a second adhesion element into a second blood vessel. The vessels may be adhered together by heating tissue using the first and second adhesion elements.

Abstract: A removable electrode assembly for use in combination with a forceps having opposing end effectors and a handle for effecting movement of the end effectors relative to one another. The electrode assembly includes a housing which is removably engageable with the forceps and a pair of electrodes which are attachable to a distal end of the housing. The electrodes are removably engageable with the end effectors of the forceps such that the electrodes reside in opposing relation relative to one another. The electrode assembly also includes a cover plate which is removably attachable to the housing and at least one stop member for controlling the distance between the opposing electrodes. The stop member is selectively engageable with the electrodes.

Abstract: Electrosurgical system with selective control of active and return electrodes. At least some of the illustrative embodiments are systems comprising an electrosurgical wand and an electrosurgical controller. The wand comprises a non-conductive outer surface, at least three electrodes disposed on a distal end of the wand, and at least three electrical leads extending from a proximal end of the wand (one electrical lead electrically coupled to each electrode). The controller comprises a voltage generator and a control circuit coupled between the voltage generator and the electrodes of the wand. The control circuit is configured to: selectively electrically couple the active terminal singly and in combination to the electrodes of the wand; and selectively electrically couple the return terminal singly and in combination to electrodes of the wand.

Abstract: Electrosurgical system with selective control of active and return electrodes. At least some of the illustrative embodiments are systems comprising an electrosurgical wand and an electrosurgical controller. The wand comprises a non-conductive outer surface, at least three electrodes disposed on a distal end of the wand, and at least three electrical leads extending from a proximal end of the wand (one electrical lead electrically coupled to each electrode). The controller comprises a voltage generator and a control circuit coupled between the voltage generator and the electrodes of the wand. The control circuit is configured to: selectively electrically couple the active terminal singly and in combination to the electrodes of the wand; and selectively electrically couple the return terminal singly and in combination to electrodes of the wand.

Abstract: Electrosurgical wands. At least some of the illustrative embodiments are electrosurgical wands having features that reduce contact of tissue with an active electrode of a wand, decrease the likelihood of clogging, and/or increase the visibility within surgical field. For example, wands in accordance with at least some embodiments may comprise standoffs, either along the outer perimeter of the active electrode, or through the main aperture in the active electrode, to reduce tissue contact. Wands in accordance with at least some embodiments may implement slots on the active electrodes to increase bubble aspiration to help keep the visual field at the surgical site clear. Wands in accordance with at least some embodiments may implement aspiration flow pathways within the wand that increase in cross-sectional area to reduce the likelihood of clogging.

Abstract: 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.

Abstract: Described here are devices, systems, and methods for forming a fistula between two blood vessels. The systems may comprise a first catheter including a housing and an electrode having a proximal end and a distal end. The proximal end is fixed relative to the housing and the distal end is longitudinally slidable within the housing.

Abstract: Electrosurgical wands. At least some of the illustrative embodiments are electrosurgical wands having features that reduce contact of tissue with an active electrode of a wand, decrease the likelihood of clogging, and/or increase the visibility within surgical field. For example, wands in accordance with at least some embodiments may comprise standoffs, either along the outer perimeter of the active electrode, or through the main aperture in the active electrode, to reduce tissue contact. Wands in accordance with at least some embodiments may implement slots on the active electrodes to increase bubble aspiration to help keep the visual field at the surgical site clear. Wands in accordance with at least some embodiments may implement aspiration flow pathways within the wand that increase in cross-sectional area to reduce the likelihood of clogging.

Abstract: A removable electrode assembly for use in combination with a forceps having opposing end effectors and a handle for effecting movement of the end effectors relative to one another. The electrode assembly includes a housing which is removably engageable with the forceps and a pair of electrodes which are attachable to a distal end of the housing. The electrodes are removably engageable with the end effectors of the forceps such that the electrodes reside in opposing relation relative to one another. The electrode assembly also includes a cover plate which is removably attachable to the housing and at least one stop member for controlling the distance between the opposing electrodes. The stop member is selectively engageable with the electrodes.

Abstract: The present disclosure includes an electrosurgical apparatus for treating tissue at a target site. The apparatus has a shaft with a proximal end and a distal portion, the distal portion comprising a return electrode and electrode support. There is also at least one active electrode on the shaft distal portion, which has a proximal portion and a distal portion and a plurality of aspiration apertures disposed therebetween. These apertures are fluidly connected to a fluid aspiration cavity that is located within the electrode support, and the cavity is connected with a fluid aspiration element that is located along the shaft. The plurality of apertures vary in size and are generally arranged so that the larger sized apertures are disposed towards the electrode proximal portion and the smaller sized apertures are generally located towards the electrode distal portion.

Abstract: An electrosurgical wand for treating tissue at a target site within or on a patient's body is described, having an elongate shaft with a handle and a distal end portion. The distal end portion has an active electrode, an insulative spacer body and a return electrode; the active electrode supported by the insulative spacer body and spaced away from the return electrode. The active electrode has both lateral and medial edge surfaces. The insulative spacer body has an aspiration cavity fluidly connected with an aspiration lumen, and at least one tapered aperture extending beyond at least one of the electrode medial edge surfaces and directed to the aspiration cavity.

Abstract: An electrosurgical wand. At least some of the illustrative embodiments are electrosurgical wands including an elongate housing that defines a handle end and a distal end, a first discharge aperture on the distal end of the elongate housing, a first active electrode of conductive material disposed on the distal end of the elongate housing, a first return electrode of conductive material disposed within the first fluid conduit, and an aspiration aperture on the distal end of the elongate housing fluidly coupled to a second fluid conduit.

Abstract: An electrosurgical wand for treating tissue at a target site within or on a patient's body is described, having an elongate shaft with a handle and a distal end portion. The distal end portion has an active electrode, an insulative spacer body and a return electrode; the active electrode supported by the insulative spacer body and spaced away from the return electrode. The active electrode has both lateral and medial edge surfaces. The insulative spacer body has an aspiration cavity fluidly connected with an aspiration lumen, and at least one tapered aperture extending beyond at least one of the electrode medial edge surfaces and directed to the aspiration cavity.

Abstract: A method comprising sealing a vessel residing within tissue between jaws of forceps by sensing an amount of tissue held within the forceps, the sensing by passing electrical current through the tissue by way of the forceps. The method comprises heating the tissue using electrical current, the heating such that impedance of the tissue changes at a first predetermined rate, the first predetermined rate selected based on the sensing. The method comprises desiccating the tissue using electrical current, such that the impedance of the tissue changes at a second predetermined rate different than the first predetermined rate. The method comprises ceasing application of the electrical current to the tissue when impedance of the tissue reaches a predetermined value. Sensing the amount of tissue held within the forceps comprises varying electrical current flowing through the tissue through the forceps such that impedance of the tissue changes at a third predetermined rate.

Abstract: Electrosurgical system and related methods that include: producing energy by a generator of an electrosurgical controller, the generator comprises a first terminal coupled to a first electrode of an electrosurgical wand, and the generator comprises a second terminal coupled to a second electrode of the electrosurgical wand; forming, responsive to the energy, a plasma proximate to the first electrode, and acting as a current return by the second electrode; reducing energy output of the generator such that the plasma proximate the first electrode is extinguished, the reducing energy output during periods of time when the electrosurgical controller is commanded to produce energy; producing energy from the generator with the first terminal coupled to the first electrode and the second terminal coupled to the second electrode; and forming, responsive to the energy, a plasma proximate to the second electrode, and acting as a current return by the first electrode.

Abstract: The present disclosure includes an electrosurgical apparatus for treating tissue at a target site. The apparatus has a shaft with a proximal end and a distal portion, the distal portion comprising a return electrode and electrode support. There is also at least one active electrode on the shaft distal portion, which has a proximal portion and a distal portion and a plurality of aspiration apertures disposed therebetween. These apertures are fluidly connected to a fluid aspiration cavity that is located within the electrode support, and the cavity is connected with a fluid aspiration element that is located along the shaft. The plurality of apertures vary in size and are generally arranged so that the larger sized apertures are disposed towards the electrode proximal portion and the smaller sized apertures are generally located towards the electrode distal portion.

Abstract: The present disclosure includes an electrosurgical apparatus for treating tissue at a target site. The apparatus has a shaft with a proximal end and a distal portion, the distal portion comprising a return electrode and electrode support. There is also at least one active electrode on the shaft distal portion, which has a proximal portion and a distal portion and a plurality of aspiration apertures disposed therebetween. These apertures are fluidly connected to a fluid aspiration cavity that is located within the electrode support, and the cavity is connected with a fluid aspiration element that is located along the shaft. The plurality of apertures vary in size and are generally arranged so that the larger sized apertures are disposed towards the electrode proximal portion and the smaller sized apertures are generally located towards the electrode distal portion.

Abstract: Electrosurgical wand. At least some of the illustrative embodiment are electrosurgical wands including: an elongate housing that defines a handle end and a distal end; an aspiration aperture on the distal end of the elongate housing the aspiration aperture fluidly coupled to a first fluid conduit, the first fluid conduit within the elongate housing; a discharge aperture on the distal end of the elongate housing, the discharge aperture fluidly coupled to a second fluid conduit, and the second fluid conduit within the elongate housing; a first active electrode of conductive material on the distal end of the elongate housing, the first active electrode between the discharge aperture and the aspiration aperture; and a conductive plate that abuts the discharge aperture, at least a portion of the conductive plate disposed over the discharge aperture.