Endovascular Embolization

in Endovascular Trauma Management

Applied

Type

Reinforcement

Confidence

72%

Created

Mar 27, 2026

Evidence

1 source

Rationale

The Wagner 2025 systematic review and guideline update is directly relevant to this section on endovascular embolization in trauma, reinforcing the existing WSES recommendation for angioembolization as first-line management of hemorrhage in severely injured patients. Because the article is flagged and its relevance score is moderate (65/100), a targeted citation addition to the existing WSES recommendation sentence is the most appropriate integration, avoiding substantive rewriting while acknowledging the updated evidence base. No new content additions are warranted without access to the full text details.

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
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, 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-k].
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