Endovascular Embolization

in Endovascular Trauma Management

Applied

Type

Reinforcement

Confidence

78%

Created

Mar 27, 2026

Evidence

1 source

Rationale

The 2025 systematic review by Wagner et al. is directly relevant to this section on endovascular embolization in trauma, providing updated guideline-level evidence supporting angioembolization for hemorrhage control in severely injured patients. Given the article's moderate relevance score (65/100) and that the existing content already covers the core indications and WSES recommendations, a citation-only integration is appropriate. The new citation is added as a reinforcing sentence at the end of the WSES Recommendation paragraph to acknowledge the updated evidence without disrupting the existing structure or duplicating content.

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-j].

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