LAUSR

We thank you for the opportunity to reply to the letter ‘NButyl Cyanoacrylate–Lipiodol Mixture For Endovascular Purpose: Polymerization Kinetics Differences Between In Vitro and In Vivo Experiments’ [1], and we are respectful to their valuable suggestions. The first issue they raised was about the use of saline to flush the catheter before injection of NBCA/Lipiodol mixture. Their point was that saline, which is rich in ions, could facilitate polymerization within the catheter. There are apparently a few papers stating that the catheters should be flushed by 5% or 10% dextrose [2, 3], but there is no study showing that adverse events occur more frequently with the use of saline. In addition, we empirically know through our routine clinical use of this technique that there have been no serious adverse events, such as adhesion of the catheter tip to the vascular wall. Flushing the microcatheters with dextrose would certainly eliminate the influence of ions, but the effect would be just temporary because blood will soon start refluxing into the catheter via its tip, due to the pressure gradients between blood vessels and within the catheters. Thus, we believe that the use of dextrose will not eliminate all the risks. They also raised a few other factors that may affect the kinetics of NBCA/Lipiodol mixture (e.g., viscosity of Lipiodol, diameter of the blood vessel, velocity of the blood flow, blood pressure, two-step polymerization process, and blood products). We do agree that the flow cessation process is probably multifactorial, and it is apparent