Devices and methods for penetrating from a vessel lumen in which a catheter device is positioned to a target location outside of that vessel lumen. A tissue penetrator advances from a catheter positioned within the vessel lumen to the target location when properly aimed. An imaging transducer fixedly mounted on or within the catheter body provides an imaging signal from which an image of the target location can be obtained. An imageable marker may be present on the catheter to form on the image obtainable from the imaging signal to predict the path that will be followed by the tissue penetrator when the tissue penetrator exits from the catheter. Alternatively, or addition thereto, the imaging transducer may comprise a plurality of imaging elements which are located so that the penetrator path indication can be obtained electronically without use of an imageable marker on the catheter.