Embolic agents in emergency care: a large retrospective cohort study

Emergency embolization is a cornerstone in the management of active bleeding and vascular lesions at risk of bleeding. This study aims to provide a comprehensive overview of emergency embolization technical modalities in a large cohort of patients, with a focus on embolic agent selection depending on vessel and lesion characteristics.

This retrospective study included consecutive patients who underwent emergency embolization procedures in an interventional radiology department between 2022 and 2024. Data collection included precise type specifications and quantity of embolic agents, diameter and location of targeted vessel, vascular-type lesions, etiology, and technical success rate.

A total of 304 patients (320 procedures, 465 artery embolizations) were analyzed. Most target arteries measured 1.0-1.9 mm in diameter (42.6%). For arteries < 1 mm (13.8%), liquid agents were preferred (46.7%), whereas coils were the most widely used in larger vessels. In active bleeding (32.7%), liquid agents (38.6%) and coils (37.3%) were the most commonly used. For spontaneously resolved bleeding lesions and pseudoaneurysms (33.1% and 14.2% of lesions, respectively), coils were widely used (34.9% and 50.8%, respectively). Coil use was associated with the highest procedural cost. Technical success was achieved in 99.1% of procedures.

In emergency embolization, small-caliber vessels (1.0-1.9 mm) were the most frequently targeted. In cases of active bleeding, liquid embolic agents were favored, with high technical success. Notably, a substantial proportion of lesions were identified on CT without ongoing bleeding at the time of embolization.

Level 4, Case Series.