Abstract: A guide wire for minimally invasive operations with a distal wire end piece (3, II) connected to a wire main piece (2), wherein the guide wire (I, 10) has, at least in the distal wire end piece (3, II), an inner shaft (4, 14) and at least one protective layer enclosing the inner shaft (4, 14), the inner shaft (4, 14) comprises a first fibre composite material and, at least in the distal wire end piece (3, II), the inner shaft (4, 14) has a plurality of weakened points (8, 18), which are created by mechanical interventions, is characterised in that the weakened points (8, 18) are created by buckling load, bending load and/or breaking load. Correspondingly, for a method for producing a guide wire of this kind it is proposed that the weakened points (8, 18) are created by buckling load, bending load and/or breaking load.

Abstract: A gastrointestinal device for treating obesity includes a three-dimensional porous structure configurable between a compressed pre-deployment configuration to facilitate delivery and an expanded post-deployment configuration. The porous structure includes a first opening at its proximal end and a larger second opening at its distal end. The porous structure also includes a sleeve coupled to its distal end. Optionally, the device further includes a suture at the proximal end of the wire mesh structure to facilitate retrieval and an anti-migration component positioned at the junction of the porous structure with the sleeve. The porous structure is deployed in a patient's stomach such that the anti-migration component sits proximal to the patient's pylorus and prevents migration of the entirety of the device into and through the pylorus. The sleeve extends through the pylorus, into the duodenum and ends in the duodenum or jejunum.

Abstract: A medical probe includes a shaft for navigation in a patient body, and first and second deflection mechanisms. The shaft ends with a flexible section and a spring, followed by a rigid distal tip having one or more medical devices coupled thereto. The first deflection mechanism is configured to deflect the flexible section relative to the shaft. The second deflection mechanism is configured to deflect the distal tip relative to the first flexible section by using the spring.

Abstract: A torque coil 10 includes an inner wire layer 14 helically wound in a constricted state. An outer wire layer 18 is helically wound over the inner wire layer in a constricted state. An outer polymer cover 20 surrounds the inner and outer layers thereby securing the inner and outer layers within the outer polymer cover.

Abstract: A brachytherapy needle guidance device is a device that facilitates the placement of a brachytherapy needle into a treatment region in tissue. This tissue may a breast tissue and the brachytherapy needle may be a fiducial needle. The brachytherapy needle guidance device may have an anchoring feature that anchors the brachytherapy needle guidance device into the tissue once it is properly positioned. The brachytherapy needle guidance device is used by software for treatment planning.

Abstract: A delivery guidewire for navigating a catheter in the heart to deliver a valve prosthesis. The delivery guidewire comprising an elongated core, an outer sleeve disposed on the elongated core, and a coil disposed on a distal portion of the elongated core. The delivery guidewire having a first section having a generally uniform diameter and a second section having a tapering section. A distal portion of the second section of the delivery guidewire comprises a pigtail shape atraumatic tip which can remain in the left ventricle.

Abstract: A catheter includes a hollow shaft, a multi-thread coil body covering the hollow shaft, and a cover member covering the multi-thread coil body. The multi-thread coil body includes a ring-shaped or substantially hollow cylindrical joint part in which distal ends of a plurality of element wires are joined in a circumferential direction, a coil main body located at a proximal side of the joint part in an axial direction, in which an outer shape of a cross section of each of the plurality of element wires is circular, and a transition part located between the joint part and the coil main body, in which a width of at least one of the plurality of element wires widens toward a distal end of the element wire.

Abstract: There is provided an endoscope capable of suppressing the degradation of a distal-end-part body over time that is caused by the sandwiching of a treatment tool. An endoscope includes a distal-end-part body that is provided at a distal end of an insertion unit. The distal-end-part body includes an elevator-housing space-forming wall that forms an elevator-housing space opened in a direction perpendicular to the direction of the longitudinal axis of the insertion unit, a lead-out portion that includes a treatment tool outlet opened into the elevator-housing space, and an elevator that is provided in the elevator-housing space so as to be rotatable about a rotating shaft between a standing position and a fallen position and includes a guide surface guiding a treatment tool. The elevator-housing space-forming wall includes an opening wall portion provided on an opening side of the elevator-housing space.

Abstract: Systems and methods are provided for injecting one or more agents into tissue within a patient's body that includes a catheter. A needle guide extends from a distal end of the catheter and terminates at a distal tip, e.g., including a foot with an atraumatic contact surface, the needle guide having a cross-section smaller than the distal end and being biased to a curved shape. The needle guide includes a passage communicating from a lumen of the catheter to an outlet at the distal tip, and a needle device is disposed within the passage that may be deployed from the outlet to inject one or more agents into tissue. The catheter also includes an imaging assembly on the distal end configured to acquire images of tissue adjacent the needle guide distal tip.

Abstract: The present disclosure relates generally to the field of medical devices and establishing access to body passageways. In particular, the present disclosure relates to devices, systems and methods to facilitate entry of an endoscopic accessory tool into and/or through patient-specific anatomies. For example, the devices, systems and methods of the present disclosure may transmit mechanical motion to the distal end of an endoscopic accessory tool to facilitate atraumatic access to tortuous or otherwise restricted anatomies.

Abstract: The invention provides devices with integrated intravascular imaging and methods for crossing a CTO within the true lumen of a vessel. An interventional catheter with intravascular imaging capabilities can be guided into an affected vessel and to a CTO. An included intravascular imaging device captures a 3D image of the environment. The catheter includes a crossing member that can be extended out from a distal tip of the catheter, causing the crossing member to directly cross through the CTO creating a new channel through the CTO.

Abstract: A dual lumen catheter with a measuring scale is disclosed. The catheter has a pair of lumens, one of which is adapted to receive a measuring scale for measuring the length of a lesion within the body. A view port is provided to allow the user to view the measuring scale and determine the length of the lesion.

Abstract: Provided is a stent delivery device that can rapidly transport a stent to an indwelling site. In one aspect, the stent delivery device includes a catheter including an inner sheath and an outer sheath allowing the inner sheath to be slidably inserted therethrough and a stent provided between the inner sheath and the outer sheath in the vicinity of a distal end of the catheter. The stent delivery device also includes a guiding elongated body inserted through an inner lumen of the inner sheath and partially exposed from the distal end of the catheter so as to guide the insertion of the catheter. The guiding elongated body has a variable tip area provided in the vicinity of a distal end of the guiding elongated body so as to change flexibility between a first state and a second state different from the first state.

Abstract: A catheter tip having a spring element that imparts longitudinal flexibility, pushability and radial rigidity to the catheter tip, thereby improving deliverability, is provided. The spring element also provides radial support to the distal edge of the catheter tip. The spring element may taper distally, but may have a substantially constant inner luminal diameter. The spring element may be partially covered or embedded, leaving its distal end exposed. The spring element may also include spaced coils in a proximal region. The apparatus may be used with any interventional catheter system, but is particularly suitable for use with balloon-expandable stent systems and balloon-angioplasty systems, where flexibility of the catheter tip and minimal flaring of the distal edge of the catheter tip is desirable.

Abstract: An intravascular device, such as s guidewire device, includes a hollow proximal section and a hollow distal section joined to the proximal section and extending distally from the proximal section to form a continuous lumen extending from a proximal end of the device to a distal end of the device. An inner member extends from the proximal end to the distal end and is joined to the distal end. The inner member is translatable within the lumen in response to applied tension. At least the distal section includes a micro-fabricated cutting pattern that enables deflection of the distal end in response to the application of tension to the inner member.

Abstract: A surgical system for selective connection to a robotic arm includes an instrument drive unit and a surgical instrument detachably coupled to the instrument drive unit. The instrument drive unit includes a first actuator, a linkage member having opposing first and second portions, and a drive member. The first portion of the linkage member is operatively coupled to the first actuator such that actuation of the first actuator moves the first portion in a first direction and the second portion in a second direction opposite of the first direction. The drive member is operatively coupled to the second portion of the linkage member. The surgical instrument includes a driven member operatively associated with the drive member of the instrument drive unit and an end effector operatively coupled with the driven member, wherein translation of the driven member effects a first function of the end effector.

Abstract: A catheter device including an internal elongated and hollow body extending between a proximal end and a distal end along a longitudinal axis, the internal elongated and hollow body defining a longitudinal aperture that extends between the proximal and distal ends thereof, the longitudinal aperture being shaped and sized for receiving a guide wire therein, and at least one mechanical waveguide secured to the internal elongated and hollow body and extending longitudinally along at least a portion of the internal elongated and hollow body, with the at least one mechanical waveguide capable of propagating at least one mechanical wave therealong.

Abstract: A guidewire made from a drawn filled tube composite wire is described. The composite wire has a stainless steel outer sheath jacketing a nitinol core wire. The drawn filled tube composite wire is ground at its distal end to expose the nitinol core, which has superelastic and kink resistant properties that are desirable for the distal end of a guidewire. The proximal end of the drawn filled tube is not ground or if ground, the outer sheath of stainless steel is not removed to an extent sufficient to expose the nitinol core.

Abstract: Devices and associated methods are disclosed for improving the fixation of the stent graft to the wall of the abdominal aortic neck and to increase the tightness of the aneurysmal sac from the main lumen of the abdominal aorta. Particular embodiments are directed to a bifurcated stent graft system for the treatment of the abdominal aortic aneurysm, which includes an aortic bifurcation segment, two iliac segments and an additional inner segment. The aortic bifurcation segment contains a main tubular body with branched legs at the distal end made of biocompatible fabric material attached to and supported by stents. The proximal end of the aortic bifurcation segment is configured to engage with a part of the aorta, without aneurysmal dilatation, proximal to the renal arteries and contains only a metal expandable frame (for example, a stent), without fabric material, but with fixing pins for engagement with the aortic wall proximal to the renal arteries.

Abstract: Guidewires and methods for transmitting electrical stimuli to a heart and for guiding and supporting the delivery of elongate treatment devices within the heart are disclosed. A guidewire can comprise an elongate body, including first and second elongate conductors, and at least first and second electrodes. A distal end portion of the elongate body can include a preformed bias shape, such as a pigtail-shaped region, on which the first and second electrodes can be located. The preformed bias shape can optionally be non-coplanar relative to an intermediate portion of the elongate body. The first and second elongate conductors can be formed of a single structure or two or more electrically connected structures. The conductors can extend from proximal end portions to distal end portions that electrically connect to the first and second electrodes.

Abstract: A device for introduction into a body vessel includes a shaft, a balloon positioned at the distal end of the shaft, a guidewire disposed longitudinally within the shaft to receive a guidewire during use, a balloon disposed at the distal end of the shaft, and longitudinal scoring wires to score a vascular lesion attached to the distal end of the shaft. The scoring wires are disposed over the balloon and disposed within the shaft. The proximal ends are welded or otherwise affixed to a spring mounted in the handle. The balloon expands when fluid is delivered to the balloon through the inflation lumen. This expansion pushes the scoring wires against the vascular lesion. The scoring wires attach to a source of vibrations. The scoring wires are made of a helical coil.

Abstract: A guide wire includes a core shaft, a coil wound around the core shaft, a distal-end joining region to which a distal end of the core shaft and a distal end of the coil are joined, and a proximal-end joining region to which a proximal end of the core shaft and a proximal end of the coil are joined, and the coil has a sparsely wound portion having a sparser coil pitch than other portions of the coil, the sparsely wound portion being disposed between the distal-end joining region and the proximal-end joining region.

Abstract: Endovascular and intravascular devices and methods of manufacturing endovascular and intravascular devices may be provided. In one implementation, an intravascular device including an elongated sheath and an elongated coil distal to the sheath may be provided. The coil may include a first coil segment formed from a plurality of wires helically-wound at a first coil angle; a second coil segment formed from a first subset of the plurality of wires that is helically-wound at a second coil angle that is different from the first coil angle; and a third coil segment formed from a second subset of the plurality of wires that is helically-wound at a third coil angle that is different from the first and second coil angles. The coil segments may be configured such that flexibility of the coil increases in a longitudinal direction toward the distal end of the coil.

Abstract: A pressure-measuring guidewire system includes a hollow guidewire (110) in sealed interconnection with a contained volume (102) of a connector (101). The contained volume is bordered on at least one side by a septum (103). A pressure sensor unit (122) includes a transducer (130) associated with a hollow needle (131) which can be inserted to penetrate the septum (103), thereby connecting the transducer with a column of fluid within an inner lumen of the guidewire (102). Priming of the guidewire is performed prior to use, typically by use of a syringe, prior to connection of the sensor unit, thereby protecting the transducer from damage from the priming pressure. Also disclosed is a guidewire tip configuration which provides effective fluid connection for pressure measurement while maintaining the properties of a conventional guidewire.

Abstract: The present invention relates to expandable sleeves, expandable sleeve systems, and their methods of use. In certain aspects, the expandable sleeves are compatible with commonly used speculums to enhance visualization and access of an orifice. The expandable sleeves sheathe over the blades of a speculum and form a taut barrier when the blades are opened to hold back the walls of a tissue orifice and cavity. The expandable sleeves include inflatable pouches that further push back the walls of the orifice. In certain aspects, the expandable sleeves are useful in performing pelvic exams, such as in patients having lax vaginal walls or excess surrounding tissue.

Abstract: A medical apparatus according to one embodiment of the present invention can be used for dissociating adhesion to an epidural space and alleviating stenosis to a spinal canal; and comprises: an insertion part including a first end configured to be inserted into a human body and a second end opposite to the first end, and having a first through hole extended from the first end to the second end and formed inside the insertion part, an expansion part configured to be expandable and formed on an outer surface of the insertion part at a predetermined distance apart from the first end of the insertion part, a pair of wires extending in the insertion part and fixed to a region of the first end of the insertion part, a main body, a dial installed to the main body, and a rotation control part coupled to the dial.

Abstract: A blood flow meter capable of measuring the flow rate of the blood flow with high accuracy in a blood vessel of a living body is provided. An element holding body having a tubular shape and having an outer diameter smaller than or equal to the outer diameter of a hollow shaft, which has flexibility and is insertable into a blood vessel, is provided on the distal side of the shaft so as to be coaxial with the shaft. A flow rate sensor is accommodated in the element holding body. The flow rate sensor has a measurement element in which a nickel wire is spirally wound to be formed into a coil shape so that adjacent nickel wires are not in contact with each other and are insulated. A thermal conductive insulating member is provided between the flow rate sensor and the element holding body in the element holding body and the flow rate sensor is fixed in the element holding body by the insulating member.

Abstract: Intravascular devices, systems, and methods are disclosed. In some instances, the intravascular device is a guide wire with electrical conductors embedded within a core wire. In some instances, the electrical conductors are coupled to conductive bands adjacent a proximal portion of the guide wire and a sensing element adjacent a distal portion of the guide wire. Methods of making, manufacturing, and/or assembling such intravascular devices and associated systems are also provided.

Abstract: According to one aspect, a guidewire assembly for positioning within a body of a patient may include a guidewire shaft having a proximal section and a distal section. The distal section may be configured to move within the body of a patient when the guidewire assembly is in a first operating state. The distal section may be configured to expand radially outward when the guidewire assembly is in a second operating state to engage an interior surface of the body and inhibit movement of the guidewire shaft.

Abstract: A guidewire for guidance of a catheter or of a catheter introducer sheath into a human patient. The guidewire has, when in untensioned condition, a curved deflection section at its distal end and a shaft with one or more curved steering sections proximal of a straight section proximally neighboring the deflection section. This facilitates steering a guidewire to a predetermined location inside the patient.

Abstract: A filler delivery device is configured to place a filler inside a bulge occurring in a body lumen. The filler delivery device includes a frame member configured to be expandable and compressible, and a tubular member through which a catheter for injecting the filler into the bulge is insertable. The tubular member is provided such that, when the frame member is in an expanded state, an open end of the tubular member is directed in a direction intersecting an extending direction of the body lumen. The filler material includes a base gel having flowability with which the filler material flows inside the catheter, and shape retainability with which the filler material stays inside the bulge after being injected from the catheter into the bulge, and a solidification promoting substance that promotes solidification of blood inside the bulge.

Abstract: Medical devices and methods for making and using the same. An example medical device may include an elongate tubular member, an endosurgery stent disposed on the outer surface of the tubular member, a push tube slidably disposed along the outer surface of the tubular member, and a push member slidably disposed in a lumen formed in the tubular member. The push member may be coupled to the push tube.

Abstract: A lung volume-reducing elastic implant (2) and a lung volume-reducing instrument; the lung volume-reducing elastic implant (2) is tubular and comprises a proximal implant end (201), an elastic deformation part (205) and a distal implant end (202); the elastic deformation part (205) is located between the proximal implant end (201) and the distal implant end (202), and the elastic deformation part (205) has a shape memory characteristic; the lung volume-reducing elastic implant (2) is opened at the proximal implant end (201); the elastic deformation part (205) is provided with a plurality of grooves (204) at intervals along the longitudinal direction thereof; each groove (204) communicates with the tube cavity of the elastic deformation part (205); the lung volume-reducing instrument comprises the lung volume-reducing elastic implant (2) and a delivery device (1) matching same; the delivery device (1) comprises a guidewire (101) and a hollow push piece (110); the lung volume-reducing elastic implant (2) is det

Abstract: A mold is used to form a solder joint to join the distal end of the guidewire to a wire coil. The mold has a cavity that can have different configurations so that the solder joint can be any of bullet shaped, micro-J shaped, cone shaped, truncated cone shaped, or have a textured surface.

Abstract: An apparatus and method of manufacture includes a helical wire coil and a core wire. The core wire has a first wire portion and a second wire portion. The first wire portion of the core wire extends through the helical wire coil. The second wire portion of the core wire is intertwined with the first helical wire coil to fixedly secure the core wire relative to the first helical wire coil. The core wire is formed from a first material that is non-extensible. The core wire is fixedly secured relative to a distal portion of the helical wire coil such that the core wire inhibits longitudinal elongation of the helical wire coil along a longitudinal coil axis.

Abstract: An apparatus includes a cannula assembly and a sensor assembly. The cannula assembly includes a proximal end, a distal end, and a first lumen extending from the proximal end to the distal end. The cannula is formed of a rigid material. The sensor assembly includes a sensor and a communication wire. The sensor is fixed to the cannula assembly. The communication wire is in electrical communication with the sensor. The communication wire extends along a length of the cannula assembly exterior to the first lumen.

Abstract: A surgical procedure kit for inserting a medical tube according to the present invention includes: an insertion pathway formation means configured to include a medical tube provided with a hollow tube main body, a tube member including a hollow conduit having the medical tube received therein and forming a pathway into which the medical tube is to be inserted, and a support member including a support rod which is inserted into the medical tube and has stiffness greater than that of the tube member; and a push means configured to be slidable within the conduit of the tube member and push the medical tube through the conduit of the tube member.

Abstract: A method and apparatus are disclosed for an RF guidewire for applying RF energy to create a channel through a region of tissue within a patient's body. The RF guidewire is configured to have a hydrophilic coating disposed thereon to reduce friction to facilitate traversal through vasculature while maintaining its mechanical, electrical and thermal properties.

Abstract: A method for measuring a distance in a body vessel and introducing an implant into the body vessel, the method comprising: providing a guide wire, wherein the guide wire comprises a proximal end and a distal end, wherein the distal end comprises a spiral which has at least two adjoining spiral sections as markings, wherein at least a surface of one spiral section comprises a first material and at least a surface of the second spiral section comprises a second material, and further wherein the first material is different than the second material; inserting the guide wire into the body vessel; measuring the distance in the body vessel using the markings on the guide wire; and delivering the implant over the guide wire to the body vessel.

Abstract: The present disclosure relates to guidewire devices having shapeable tips and effective torquability. A guidewire device includes a core having a proximal section and a tapered distal section. A tube structure is coupled to the core such that the tapered distal section extends into the tube structure. The tube structure includes a plurality of bypass cuts formed tangentially within the tube structure to increase the flexibility of the tube structure and to reduce the tendency of resilient forces from the tube structure to disrupt a shaped distal tip of the guidewire device.

Abstract: A robotic device for performing intracranial procedures, comprising a baseplate for mounting on the subject's skull and a rotatable base element rotating on the baseplate. The rotatable base element has a central opening through which a cannulated needle can protrude such that it can rotate around an axis perpendicular to the baseplate. This cannulated needle is robotically controlled to provide motion into and out of the subject's skull. A flexible needle is disposed coaxially within the cannulated needle, and it is controlled to move into and out of a non-axial aperture in the distal part of the cannulated needle. Coordinated control of the insertion motion of the cannulated and flexible needles, and rotation of the combined cannulated/flexible needle assembly enables access to be obtained to a volume of a region of the brain having lateral dimensions substantially larger than the width of the cannulated needle.

Abstract: A delivery system for an implantable medical device includes an outer shaft defining an outer shaft lumen and an inner shaft translatable within the outer shaft lumen, the inner shaft defining a lumen extending through the inner shaft. An actuation mechanism extends through the lumen and includes a coupler, a force translation rod that extends proximally from the coupler and a plurality of push pull rods that extend distally from the coupler and that releasably couple to the implantable medical device. The force translation rod includes a transition in electromagnetic permeability. The delivery system includes an inductive coil disposed relative to the force translation rod and positioned to detect a change in inductance resulting from the transition in electromagnetic permeability passing through the inductive coil.

Abstract: A vascular intervention device delivery system, such as for implanting a self expanding stent, includes a thumbwheel rotatably mounted in a handle. A catheter has a proximal end attached to the handle and a distal carrier segment for mounting a stent thereon. A retractable sheath is movable to a position retracted proximally to uncover the distal carrier segment. A pull with a curved cross section extends between the thumbwheel and the retractable sheath. An idler wheel with a perimeter notch is rotatably mounted in the handle proximal to the thumbwheel. A pin is movably in the handle between a first position received in the perimeter notch to block rotation of the idler wheel, and a second position outside of the perimeter notch to permit rotation of the idler wheel. The pull wraps around the idler wheel to return in a direction for being wound onto a spool of the thumbwheel.

Abstract: A tool adapted for insertion into a physiological lumen of a patient is provided. The tool includes a hub, a core extending distally from the hub, and a printed circuit board (PCB) assembly. The PCB assembly includes a PCB substrate coupled to the core and an electronic component disposed on the PCB substrate and electrically coupled to the hub. The tool further includes an outer sheath disposed about each of the core and the PCB assembly. The PCB substrate may be in the form of a ring disposed at a distal end or about the core or may be a flexible PCB substrate adapted to be wrapped about the core and coupled to the core using an adhesive backing.

Abstract: In one embodiment, a surgical instrument comprises an articulable waveguide. The articulable waveguide may be configured to transmit ultrasonic energy therealong. The articulable waveguide comprises a proximal drive section, an end effector and a first flexible. The proximal drive section is configured to couple to an ultrasonic transducer. The end effector is located at a distal portion of the articulable waveguide. The first flexible section comprises a flex bias and be positioned between the proximal drive section and the end effector. The surgical instrument further comprises a first tine extending longitudinally relative to the articulable waveguide.

Abstract: The invention relates to a balloon catheter (1), which allows esophageal injuries to be prevented by the displacement of the esophagus of a patient during catheter ablation for cardiac arrhythmias. For this purpose, three balloons (7, 9, 11) are provided along a catheter shaft (3), which are arranged at a distance from each other and can each be alternately expanded in opposite directions.

Abstract: A balloon ablation catheter includes a catheter shaft containing a reinforcement wire in a thick section; a balloon provided at an end of the catheter shaft; and a high-frequency electric current electrode arranged in the balloon; which balloon ablation catheter satisfies L>t, wherein L represents the shortest distance from the surface of the reinforcement wire to the surface of the catheter shaft, and t represents the wall thickness of the thinnest portion of the balloon.

Abstract: A method for producing a guidewire, the method includes producing a position sensor by providing a shaft-section having a solid profile, which is sized and shaped to move in an anatomical material transportation system. A wire is wound around an axis of the shaft-section and first and second ends of the wire are coupled to respective first and second locations on an outer surface of the shaft-section. A guidewire-shaft is provided, and the position sensor is coupled to a distal end of the guidewire-shaft.

Abstract: Intraluminal and endovascular devices and methods of manufacturing intraluminal and endovascular devices may be provided. In one implementation, an intraluminal device may include a sheath having a flexible distal bending segment and a core wire arranged within the sheath. The core wire may include a distal end portion doubled back in a loop within the sheath such that the distal tip of the core wire is situated proximally from the loop. The intraluminal device may also include a movement restrictor within the sheath that is configured to limit axial movement of the distal tip of the core wire. Limiting the axial movement of the core wire distal tip may cause the loop of the core wire to buckle, resulting in a bend in the distal bending segment of the sheath, when a force is exerted on the core wire.

Abstract: A system for creating an endoluminal valve from a blood vessel wall, includes: a tubular assembly having a longitudinal axis, a proximal end, a distal portion with a distal end, and a first lumen extending from the proximal end to a distal port located proximate the distal portion, the distal port located along the longitudinal axis, the distal portion having a supporting surface on a same side of the tubular assembly as the distal port, the supporting surface extending in a longitudinal direction and offset from a surface of the tubular assembly proximal the distal port and configured to contact the blood vessel wall; and a tissue dissection probe disposed within the first lumen, the tissue dissection probe having a fluid delivery lumen extending to a fluid delivery port located at a distal end of the tissue dissection probe, the tissue dissection probe configured to be inserted into the blood vessel wall.