The invention relates to methods of transvascular retrograde access placement into a central blood vessel and to devices that facilitate these methods. The method includes positioning a vascular catheter within the vessel such that its distal end faces a desired exit site on the vessel wall, passing a penetrating device from the catheter through the vascular exit site and skin of the patient； and passing a secondary vascular catheter through the exit site and into the central blood vessel. In another aspect, the method includes penetrating outward from within the vessel to form a pass-through site on a wall of the vessel that exits the patient； and placing the vascular access device into the vessel through the pass-through site. Typical vessels that may be accessed include central veins, but may include other veins as well as arteries. Devices that facilitate the method include a stiff intravascular guidewire with a distally-mounted penetrating device such as a needle, and a two-channel vascular catheter with an angled tip.
