Defining proximal as toward the heart and distal as away from the heart, a sheath includes a proximal opening and multiple fenestrations maintainable in position slightly beyond a site or point of sheath entry into a vessel by way of an anchoring assembly having a set of radially displaceable anchoring elements configured for abutting a superficial vessel wall. The fenestrations and/or anchoring element(s) are arranged obliquely or non-obliquely around peripheral portions of the sheath. The sheath can receive blood from a pumping source at a proximal opening, and channel the blood toward, to, and through the fenestrations. The fenestrations, in combination with the proximal opening, enable the perfusion of blood into the cannulated vessel in a set of distal directions for perfusing a distal tissue or organ. Flow of blood out of fenestrations directs blood distally towards the limb, head, or other distal region, mitigating the risk of or preventing ischemia.
