Endovascular Embolization

in Endovascular Trauma Management

Applied

Type

Modification

Confidence

90%

Created

Mar 27, 2026

Evidence

1 source

Rationale

The section was updated to include the most recent clinical practice guideline (Wagner 2025) regarding endovascular management of hemorrhage in trauma. This reinforces existing indications and provides a more current evidence base. Additionally, abbreviations (NBCA, AV, WSES) were expanded on first use as per the instructions.

Evidence

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

PubMed DOI

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-e]
- Solid-organ trauma (spleen, liver, kidney) [@wagner2025-e]
- Junctional or retroperitoneal bleeding

**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 management for hemorrhage and vascular lesions in patients with multiple or severe injuries [@wagner2025-e].

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