A catheter and tissue cutting system percutaneously permits the creation of ananastomosis between a first and secondanatomical structure, such as a vein and an artery. The system comprises acatheter having a main body with a lumen and tapered distaltip, configured to be moved distally into the first anatomical structure overa primary guidewire. A cutting electrode is nested in themain body, with a lumen which tracks over a secondary guidewire, and isinsertable into the secondary anatomical structure. An energysupply is operative to energize the cutting electrode in order to cut a tissuewall defining the first anatomical structure.
