Tessari Method for Foam Sclerosant by Dr. Peter Bream

Using the Tessari Method for foam sclerosant creation is quick and simple. In the video, a large volume of sclerosant is created for Balloon Occlusion Retrograde Transvenous Obliteration (BORTO). Other ratios of air, STS and lipiodol work equally well. Dr. Bream uses the following volumes to create a 3-2-1 ratio of air, STS and Lipiodol. You will need 10 mL Lipiodol, 20 mL of 3% STS, and 30 mL of room air to create 60-75 mL of foam. Other material include three 3 mL polycarbonate syringes, one 10 mL polycarbonate syringe, two 20 mL polycarbonate syringe, three polycarbonate three-way stopcocks, two 60 mL syringes, a filter needle, and a hemostat.

1. Begin by adding 20 mL of 3% Sodium Tetradecyl Sulfate into the 60 mL syringe.
2. Using a filter needle, draw up 10 mL of Lipiodol into a 20 mL polycarbonate syringe. Use the hemostat to remove the filter needle.
3. Connect the two syringes with a stopcock and inject the Lipiodol into the Sodium Tetradecyl Sulfate.
4. Using both 60 mL syringes and stopcock, agitate the mixture of air, Sodium Tetradecyl Sulfate, and Lipiodol. This mixture will expand to give more than 60 mL of foam.
5. Attach the 20 mL polycarbonate syringe and transfer the foam.
6. Attach a 3 mL polycarbonate syringe to the stopcock to draw up a portion for treatment. The smaller syringe will allow for a more controlled administration of the sclerosant.