Endovascular embolization for treating hemothorax: caveats and considerations

Thoracic trauma is the third leading cause of death in all age groups. Around a quarter of trauma mortalities is related to thoracic trauma, with a portion of the patients developing a hemothorax requiring surgical intervention. Recently, endovascular embolization has seen a rise in usage as a less invasive alternative to surgical intervention in treating hemothorax. However, larger series and trials comparing efficacy and complication have yet to be completed. In this case series and narrative review of available literature, we described our experience with the endovascular treatment of hemothoraces, and performed a literature review of smaller series on efficacy and re-intervention rates of endovascular embolization compared to surgical intervention. Smaller described cohorts show efficacy rates of up to 93% of endovascular embolization in achieving hemostasis in traumatic hemothorax, with up to 68% needing surgical re-intervention. Based on our experiences and available literature, we propose a clinical algorithm when considering embolization instead of immediate surgical intervention.

The online version contains supplementary material available at 10.1007/s12055-026-02202-y.