Uncontrolled hemorrhage remains a leading cause of preventable death in trauma patients [1,2]. Historically, definitive control of bleeding relied on surgical laparotomy, a strategy associated with substantial morbidity and mortality [3,4]. Despite advances in trauma systems, mortality after emergent laparotomy remains high, highlighting the need for less invasive approaches [5].

Over the past two decades, vascular surgery has transitioned from a predominantly open specialty into one that routinely employes advanced endovascular techniques [6,7]. The EVTM (EndoVascular resuscitation and Trauma Management) concept provides a framework for rapid and definitive hemorrhage control in unstable patients by integrating open surgery, endovascular interventions, and resuscitation strategies within hybrid settings [8–10].

In most centers, acute embolization is performed by interventional radiologists. Current guidelines strongly recommend transarterial embolization as first‑line therapy for parenchymal organ hemorrhage [11–15]. Given their expertise in both open and endovascular surgery, vascular surgeons are uniquely positioned to incorporate embolization into emergency care.

To illustrate the practical application of vascular surgeon‑led embolization within the EVTM framework, we present four cases of artery embolization performed at Örebro University Hospital (Table 1). All procedures were performed by vascular surgeons trained in endovascular techniques within the Swedish national vascular surgery curriculum, without additional interventional radiology fellowship training. Their endovascular competence is maintained through elective practice, EVTM workshops, and simulation‑based training. Trauma cases are initially managed in a hybrid emergency room (ER) with computed tomography (CT) capability, where vascular surgeons function as integrated members of the trauma team.

In most institutions, acute embolization is performed by interventional radiologists. In contrast, our center has adopted a model in which vascular surgeons are responsible for all emergency embolizations. Embedded within the EVTM framework, this approach streamlines workflows, minimizes inter‑specialty hand‑offs, and ensures immediate readiness for hybrid conversion [8,10].

The evolution of vascular surgery into an endovascular specialty, parallels international recommendations. In a European guideline on endovascular hemorrhage management, transarterial embolization is strongly endorsed as the first‑line therapy for parenchymal organ bleeding [15]. This is consistent with World Society of Emergency Surgery (WSES) guidelines for splenic, hepatic, renal, and pelvic trauma, all of which support embolization as an essential treatment strategy [11–14]. Similarly, Hörer et al. emphasized embolization as a cornerstone of the EVTM concept, increasingly applied even in hemodynamically unstable patients when combined with adjuncts such as REBOA and performed in hybrid settings [8]. For patients with life‑threatening hemorrhage, having a single team responsible for resuscitation, definitive endovascular control, and immediate readiness for open surgery ensures a seamless continuum of care. In Case 4, for example, a massive gastrointestinal bleed was managed entirely by the vascular team, transitioning directly from REBOA placement to multivessel embolization without delay. Such continuity of care minimized critical time to hemostasis in a situation where minutes determined survival.

From a hospital perspective, consolidating responsibility for diagnosis, embolization, and surgical intervention within one specialty enhances efficiency and resource use. It reduces dependence on multiple on‑call specialists, simplifies logistics, and guarantees hybrid readiness. Unlike interventional radiology, which is often available only during working hours, the vascular surgery service provides continuous 24/7 coverage. In addition, the vascular team’s ability to perform both endovascular and open procedures within the same setting ensures hybrid readiness and minimizes the risk of fragmentation of care.

The feasibility of such models has been validated elsewhere. Kwon et al. demonstrated that trauma surgeons with vascular training performed emergency embolization with outcomes equivalent to those of interventional radiologists, with no differences in rebleeding, reintervention, or mortality [16]. Other studies confirm that trained acute care or trauma surgeons can perform catheter‑based hemostatic procedures safely and effectively, expanding access to embolization in time‑critical scenarios [6,17–19].

Finally, repeated exposure to acute embolization reinforces technical proficiency across vascular surgery. Skills developed in emergency settings, wire manipulation, catheter navigation, and decisive hemostatic strategies, translate directly into elective procedures with high hemorrhagic risk, such as aortic repairs [20–22].

Our experience demonstrates that vascular surgeon‑led acute embolization within the EVTM framework is a safe and effective approach for managing both traumatic and non‑traumatic hemorrhage. Vascular surgeons can perform endovascular procedures with outcomes comparable to interventional radiologists, while offering additional advantages such as faster decision‑making, hybrid readiness, immediate conversion capability and continuity of care. This model has proven effective in our institution and may serve as a framework for other centers, complementing interventional radiology and strengthening multidisciplinary emergency care.