A catheter set for forming a fistula

A crossing catheter for forming a fistula between two adjacent blood vessels, comprising:

• a catheter shaft defining a longitudinal axis and having a distal end section;
• a stabilizing element disposed in the distal end section of the catheter shaft;
• and
• a penetration tool for penetrating vessel walls of the two adjacent blood vessels to form the fistula, wherein the penetration tool is disposed within the catheter shaft and is movable between a retracted position and an advanced position;
• wherein the stabilizing element comprises an expandable cage having a contracted configuration and a laterally expanded configuration, and
• wherein the expandable cage is adapted to snare a guidewire when moving from the laterally expanded configuration to the contracted configuration.

A method for bypassing a total chronic occlusion in a blood vessel using a first and second crossing catheter, each crossing catheter comprising a catheter shaft defining a longitudinal axis and having a distal end section, a stabilizing element comprising an expandable cage disposed in the distal end section of the catheter shaft, and a penetration tool disposed within the catheter shaft, the method comprising:

• introducing the first crossing catheter into the blood vessel comprising the total chronic occlusion from a first side;
• advancing the first crossing catheter to a first position adjacent the chronic total occlusion;
• stabilizing the first crossing catheter by moving the stabilizing element of the first crossing catheter from a contracted configuration to a laterally expanded configuration;
• forming a first fistula between the blood vessel and an adjacent blood vessel by moving the penetration tool of the first crossing catheter from a retracted position to an advanced position and penetrating vessel walls between the two adjacent blood vessels;
• moving the stabilizing element of the first crossing catheter from the laterally expanded configuration to the contracted configuration;
• translating the first crossing catheter through the first fistula into the adjacent blood vessel;
• introducing the second crossing catheter into the blood vessel comprising the total chronic occlusion from a second side;
• advancing the second crossing catheter to a second position adjacent the chronic total occlusion on the opposite side to the first position;
• moving the stabilizing element of the first crossing catheter from a contracted configuration to a laterally expanded configuration;
• stabilizing the second crossing catheter by moving the stabilizing element of the second crossing catheter from a contracted configuration to a laterally expanded configuration;
• forming a second fistula between the blood vessel and the adjacent blood vessel by moving the penetration tool of the second crossing catheter from a retracted position to an advanced position and penetrating vessel walls between the two adjacent blood vessels;
• passing a guidewire through the second fistula from the first blood vessel to the second blood vessel;
• snaring the guidewire with the stabilizing element of the first crossing catheter by moving from the laterally expanded configuration to the contracted configuration;
• pulling the first crossing catheter and the guidewire through the first fistula into the blood vessel.