Endovascular Embolization

in Endovascular Trauma Management

Applied

Type

Addition

Confidence

90%

Created

Mar 26, 2026

Evidence

2 sources

Rationale

The section was updated to include a new elective indication (pelvic congestion syndrome) and to reinforce existing trauma indications with the latest 2025 clinical practice guidelines. Abbreviations (NBCA, AV, PCS, CT, WSES) were expanded on first use within the section as per instructions. The table structure and existing citations were preserved.

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). Diagnostic and Interventional 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. European Journal of Trauma and Emergency Surgery. 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**World Society of Emergency Surgery (WSES) Recommendation**: Angioembolization as first-line for uncontrolled pelvic bleeding where available, with preperitoneal pelvic packing as complementary when angiography is delayed [@coccolini2017-wses]. Updated clinical practice guidelines reinforce the use of endovascular embolization for managing vascular lesions and hemorrhage in patients with multiple or severe injuries, particularly for arterial extravasation identified on computed tomography (CT) [@wagner2025-d].
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