CIRSE Standards of Practice for the Use of Non-sclerosant Liquid Embolic Agents in IR Practice

Non-sclerosant liquid embolic agents are safe and effective embolics that have been used in interventional radiology for more than 50 years, in both emergency and elective scenarios.

This document aims to review the chemical principles and technical considerations involved, to make recommendations regarding clinical indications for the use of non-sclerosant liquid embolic agents, and to review the literature regarding outcomes and complications. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but to recommend a reasonable approach to, and best practices for, procedural performance, in this instance the use of non-sclerosant liquid embolic agents.

The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in non-sclerosant liquid embolic agents and a research assistant (P.R.). The writing group reviewed the existing literature on non-sclerosant liquid embolic agents, performing a pragmatic evidence search using PUBMED and EMBASE focussing on English-language publications, preferably from 2009 up to December 2025, and including more than ten patients. Where clear gaps were evident, older literature was searched and select references included. The final recommendations were formulated through consensus.

Non-sclerosant liquid embolic agents are represented by cyanoacrylates and polymers which are safe and effective agents that can be used in a wide range of clinical scenarios, resulting in effective embolization even in patients with impaired coagulation function. Knowing their chemical properties provides understanding of their correct preparation, technical application and clinical indication. Compared to mechanical and particulate agents, non-sclerosant liquid embolic agents present a steeper learning curve, and thus, thorough training in their use is essential.