Embolization agents vary from temporary to permanent [18]. An example of a temporary agent is Gelfoam, which can be administered as a slurry or as pledgets. Permanent agent includes coils, vascular plugs, or even covered stents. Gelfoam is most appropriate in embolizing the pelvis where there may be multiple foci of bleeding. As Gelfoam acts as a liquid embolic, it can diffuse into multiple areas of bleeding. Gelfoam is metabolized by the body and allows for recanali­zation of the embolized vessels in approximately 2weeks. Permanent agents such as coils or vascular plugs are appro­priate for a focal injury or vessel truncation. For dominant vessels that require distal perfusion, a covered stent can be used to cover the area of injury. Stent grafts can be placed to cover a “hole” in a vessel and maintain a patent lumen (Fig.33.2) [19].

Preoperative evaluation of patients prior to pelvic and extremity angiography will be based on the review of avail­able imaging. The location of the suspected sight of bleed­ing will weigh heavily on the plan for accessing the vascular anatomy.