Endovascular Embolization

in Endovascular Trauma Management

Applied

Type

Reinforcement

Confidence

72%

Created

Mar 27, 2026

Evidence

1 source

Rationale

The 2025 Wagner systematic review and clinical practice guideline update is directly relevant to this section on endovascular embolization in trauma. It reinforces the existing recommendation for angioembolization in hemorrhage control for severely injured patients. Because the article is flagged and its specific findings are not detailed beyond the title, a conservative citation_only approach is appropriate — adding a supporting citation to the existing WSES recommendation sentence rather than making substantive content changes. No existing content is contradicted.

Evidence

Wagner HJ. 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. DOI: 10.1007/s00068-024-02719-0.

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, Onyx | Distal vessels, AV fistulae |

**Indications**:
- Pelvic hemorrhage (pelvic ring fractures) [@coccolini2017-wses]
- Solid-organ trauma (spleen, liver, kidney)
- Junctional or retroperitoneal bleeding

**WSES Recommendation**: Angioembolization as first-line for uncontrolled pelvic bleeding where available, with preperitoneal pelvic packing as complementary when angiography is delayed [@coccolini2017-wses]. A 2025 systematic review and clinical practice guideline update further supports endovascular management of hemorrhage and vascular lesions in patients with multiple and/or severe injuries [@wagner2025-i].

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