Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a system and method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The system and method includes inserting an intramural crossing device into the vascular lumen, positioning at least the distal tip of the crossing device in the vascular wall, advancing an orienting device over the crossing device such that an orienting element of the orienting device resides in the vascular wall, inserting a re-entry device, and re-entering the true vascular lumen.
