The invention provides methods, systems and devices for creating a blood flow pathway to treat a patient. The system is provided for creating an arteriovenous flow pathway in a patient and comprises: a vessel-to-vessel guidewire； a needle delivery device constructed and arranged to place the vessel-to-vessel guidewire from a starting vessel to a target vessel； a flow creation device constructed and arranged to be advanced over the vessel-to-vessel guidewire and to create a flow pathway between the starting vessel and the target vessel； and a stent for positioning in a vessel. At least one of the starting vessel or the target vessel is a vein, and the other of the starting vessel or the target vessel is an artery. The stent is constructed and arranged to be positioned in the vein and to at least one of prevent or treat venous stenosis.
