Figure 2.

Consecutive steps of the internal transjugular approach (ITA) in case of free-floating leads with anchored tips. (A) A tip deflecting wire is advanced via the femoral vein in order to assess the possibility to grasp the lead and to move it. (B) Once the lead has been grasped, it is pulled down in the inferior vena cava; a Lasso, introduced through the internal jugular vein, is advanced near the proximal end of the lead. (C) The lead is caught by the lasso and then pulled up and exposed through the jugular vein. (D) Dilatation using a dilating sheath is performed. See the text for further details. TDW, tip deflecting wire; FF, free-floating lead.