Central venous access system

1. A method for acquiring access to the central venous system of a patient at a target location near an occlusion of a jugular vein, comprising the steps of:

introducing a guide catheter into a blood vessel at a location remote from said occlusion;

advancing a needle wire having a sharp end transvascularly through the guide catheter until its sharp end is adjacent the occlusion;

rotationally adjusting said needle wire until its sharp end is aimed toward the desired skin exit location;

advancing the needle wire to puncture the blood vessel from the inside out at a vascular exit site adjacent the occlusion, thereby establishing a tissue track;

further advancing the needle wire along said tissue track thereby extending said tissue track to puncture the skin from the inside out near said vascular exit site.

2. The method of claim 1 further including the steps of: enlarging said tissue track by sequential dilation.

3. The method of claim 2 wherein said enlarging step includes;

clamping said needle wire and said dilation stylet together and drawing them together from said target location.

4. A method for acquiring access to the central venous system of a patient near an occlusion, comprising the steps of:

identifying an exit point target site on the exterior skin of a patient near an occlusion;

introducing a needle wire having a sharp end into a blood vessel at a location remote from said occlusion;

advancing the needle wire through the vascalature until its sharp end is adjacent the occlusion;

aiming the sharp end of the needle wire toward the exit point target; and

advancing the needle wire through the occlusion and through the blood vessel until it becomes exteriorized at the exit point target to establish a tissue track from the blood vessel to the exterior of the patient.

5. The method of claim 4 , further comprising introducing a guide catheter with a lumen into the patient at the location remote from the patient and advancing the guide catheter to the occlusion.

6. The method of claim 5 , comprising advancing a dilation stylet through the guide catheter to the occlusion, the dilation stylet having a lumen for receiving the needle wire.

7. The method of claim 6 , further comprising pulling the dilation stylet out of the body through the exit point to enlarge the tissue track created by the needle wire.

8. The method of claim 6 , wherein the step of aiming the sharp end of the needle wire comprises rotating the dilation stylet.

9. A method for acquiring access to the central venous system of a patient near an occlusion, comprising the steps of:

identifying an exit point target site on the exterior skin of a patient near an occlusion;

introducing a guide catheter having a first lumen into a blood vessel at a location remote from the exit point target site and advancing the guide catheter to the occlusion;

advancing a dilation stylet having a second lumen through the guide catheter lumen to the occlusion;

advancing a needle wire with a sharpened end through the dilation stylet lumen so that the sharpened end is adjacent the occlusion;

aiming the sharp end of the needle wire toward the exit point target; and

advancing the needle wire through the occlusion and through the blood vessel until it becomes exteriorized at the exit point target to establish a tissue track from the blood vessel to the exterior of the patient.

10. The method of claim 9 , wherein the remote site comprises a femoral vein in a groin of the patient.

11. The method of claim 9 , further comprising placing an introducer sheath in the tissue track.

12. The method of claim 9 , further comprising pulling the dilation stylet out of the body through the exit point to enlarge the tissue track created by the needle wire.

13. The method of claim 12 , further comprising introducing a canalization wire into the dilation stylet.