Endovascular Embolization

in Endovascular Trauma Management

Applied

Type

Modification

Confidence

90%

Created

Mar 26, 2026

Evidence

2 sources

Rationale

The section was updated to include a broader range of indications for endovascular embolization, specifically adding pelvic congestion syndrome (PCS) based on new expert consensus. The trauma-related content was reinforced with a 2025 systematic review and guideline update. Abbreviations were expanded on first use per the instructions to ensure clarity for an international audience.

Evidence

Pennec VL, et al. Endovascular management of pelvic congestion syndrome: An expert consensus statement from the French Society of Cardiovascular Imaging (SFICV), Interventional Radiology Federation (FRI), College of French Radiology Teachers (CERF), and French Society of Women's Imaging (SIFEM). Diagn Interv Imaging. 2025. PMID: 40312243.
Verified source
PubMedDOI
Wagner HJ, et al. Endovascular management of haemorrhage and vascular lesions in patients with multiple and/or severe injuries: a systematic review and clinical practice guideline update. Eur J Trauma Emerg Surg. 2025. PMID: 39820621.
Verified source
PubMedDOI

Content Changes

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**Table 16.3. Endovascular Embolization Agents and Applications**

| **Agent Type** | **Examples** | **Best For** |
| --- | --- | --- |
| **Coils** | Pushable, detachable | Large vessel occlusion, pseudoaneurysms |
| **Vascular Plugs** | Amplatzer | Rapid large vessel occlusion |
| **Gelfoam** | Absorbable gelatin | Temporary hemostasis, small vessels |
| **Liquid Embolics** | NBCA,N-butyl cyanoacrylate (NBCA), Onyx | Distal vessels, AVarteriovenous (AV) fistulae |

**Indications**:
- Pelvic hemorrhage (pelvic ring fractures) [@coccolini2017-wses][@coccolini2017-wses; @wagner2025-d]
- Solid-organ trauma (spleen, liver, kidney) [@wagner2025-d]
- Junctional or retroperitoneal bleeding
- Pelvic congestion syndrome (PCS) [@pennec2025]

**WSES Recommendation**: AngioembolizationThe World Society of Emergency Surgery (WSES) recommends angioembolization as first-line for uncontrolled pelvic bleeding where available, with preperitoneal pelvic packing as complementary when angiography is delayed [@coccolini2017-wses]. Recent clinical practice guidelines continue to support endovascular management for hemorrhage and vascular lesions in severely injured patients [@wagner2025-d].
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