Hemostatic Embolization

Background and indications

Hemostatic embolization is an emergency endovascular intervention to occlude an artery responsible for active bleeding. It is a vital minimally invasive treatment for life-threatening hemorrhages, as an alternative or complement to surgical hemostasis. Main indications include:

• Post-traumatic hemorrhage (spleen, liver, kidney, pelvis — trauma management)
• Gastrointestinal hemorrhage (ulcers, diverticula, angiodysplasia, post-surgical)
• Post-operative hemorrhage (after pancreatectomy, hepatectomy, pelvic surgery)
• Hemoptysis (bronchial arteries — tuberculosis, aspergilloma, cancer)
• Severe epistaxis refractory to packing
• Obstetric hemorrhage (post-partum — see dedicated page)

Pre-procedure assessment

In emergency, contrast-enhanced CT (arterial and portal phase) is the key examination: it localizes active bleeding (contrast extravasation) and guides catheterization. Blood panel (CBC, coagulation, blood type/crossmatch) and hemodynamic resuscitation (fluid, transfusion) proceed in parallel.

Procedure

Under local anesthesia (± sedation or general anesthesia if patient unstable), a catheter is introduced through the femoral artery. Under fluoroscopic guidance, arteriography identifies the bleeding site. The responsible artery is super-selectively catheterized and embolization performed with microparticles (PVA, gelatin), microcoils, or acrylic glue depending on context. Embolization must be as selective as possible to minimize organ ischemia. The procedure takes 1 to 3 hours.

Results and scientific evidence

Technical success rate (bleeding cessation) is 85-95%. For gastrointestinal hemorrhage, recurrence rate is 10-20% (retreatable by embolization or surgery). For splenic and hepatic trauma, embolization revolutionized management by enabling non-operative treatment in 80-90% of cases. For hemoptysis, bronchial artery embolization offers immediate control in 90-95% of cases.

Risks and complications

Organ ischemia (5-10%, usually partial and reversible), non-target embolization (2-5%), post-embolization syndrome (pain, fever: 20-30%), hemorrhagic recurrence (10-20%). Mortality relates to initial hemorrhage severity and comorbidities, not the procedure itself.

Recovery

ICU or continuous monitoring hospitalization depending on severity. Control CT at 24-48h. Recovery depends on clinical context.

Practical information

The procedure is performed as an emergency inpatient procedure. It is performed by an interventional radiologist, in coordination with the intensivist, surgeon, and on-call teams.