# Emergency embolization of acute hemorrhage: cone-beam computed tomography with advanced planning and guidance software—a systematic review and case series

## TL;DR

This paper reviews the use of cone-beam CT with planning software for emergency hemorrhage embolization and shows it is effective and feasible.

## Contribution

Presents a systematic review and case series demonstrating the effectiveness of CBCT with APG software in acute hemorrhage embolization.

## Key findings

- CBCT with APG software achieved a 94.3% technical success rate in hemorrhage embolization.
- Lower gastrointestinal tract was the most common bleeding site (62%).
- Initial institutional experience showed 100% technical success in six cases with favorable outcomes.

## Abstract

This study evaluates the current evidence on the use of cone-beam computed tomography (CBCT) combined with advanced planning and guidance (APG) software in transarterial embolization for acute hemorrhage and reviews our institution’s preliminary experience of use in emergency settings.

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, SCOPUS, and Embase were searched to identify studies using CBCT with software for transarterial embolization of hemorrhage. Inclusion criteria focused on studies utilizing CBCT and APG software for hemorrhage management, with data extracted on demographics, hemorrhage locations, equipment/software specifications, technical success and procedural metrics. Additionally, we report a single-center review of patient outcomes using CBCT with multi-organ APG software (EmboASSIST with Virtual Injection, GE HealthCare, Chicago, IL, USA).

Nine studies met the inclusion criteria, including 71 patients. The most common site of bleeding was the lower gastrointestinal (GI) tract (62%). The mean technical success rate of embolization utilizing CBCT with APG was 94.3% (range: 82–100%). Three studies reported procedure time (mean 98.9 min, range 50–146 min), and two studies reported fluoroscopy time (mean 27.1 min, range 25–29.1 min). In our initial experience, all six cases were technically successful with favorable outcomes.

CBCT with APG software is a feasible and effective tool for hemorrhage embolization in emergency settings. Its potential ability to improve bleeding detection compared to digital subtraction angiography (DSA) may lead to reduced procedure time, lower radiation exposure, and enhanced patient outcomes.

NIHR-PROSPERO CRD 42024619227