Prevention and management of bleeding complications in interventional ultrasound: an international expert consensus statement
Year: 2026
Type: article
Abstract: Interventional ultrasound has become an essential minimally invasive modality in modern medicine, encompassing biopsy, drainage, sclerotherapy, and ablation. With the growing complexity of procedures and expanding clinical indications, bleeding complications have emerged as a critical concern, potentially compromising treatment outcomes and posing life-threatening risks in severe cases. However, no systematic international consensus exists on the prevention and management of these complications. This international expert consensus statement was developed by a multidisciplinary panel of 51 specialists from six countries. The development process followed the World Health Organization Handbook for Guideline Development, was reported in accordance with the Reporting Items for Practice Guidelines in Healthcare statement, and was appraised using the Appraisal of Guidelines for Research and Evaluation II instrument. Evidence quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach, and recommendations were refined through a two-round modified Delphi process. A total of 20 recommendations were finalized, covering classification, risk assessment, periprocedural prevention, post-procedural monitoring, and stepwise management of bleeding complications. A dual classification based on time of onset and severity is proposed to support standardized clinical communication and decision-making. Multidimensional pre-procedural risk assessment incorporates procedural risk, patient-related factors, lesion characteristics, device-related factors, and operator experience. The recommendations also address individualized periprocedural management, risk-adapted post-procedural ultrasound surveillance, and stepwise hemostatic management ranging from local compression and tract embolization to selected ultrasound-guided interventions, transarterial embolization, and surgery. These recommendations provide a practical framework for clinical decision-making across a broad range of interventional ultrasound procedures while allowing individualized application according to procedural characteristics, patient-related risk factors, operator experience, and institutional resources. The available evidence remains heterogeneous across procedures, and some recommendations are partly dependent on expert opinion where high-quality direct evidence is limited. This consensus statement provides a standardized, evidence-based framework to guide clinical practice, improve patient safety, and optimize procedural outcomes in interventional ultrasound. Further multicenter prospective studies are needed to validate and refine these recommendations.
Source: BMC Medicine
Authors: Min Xu, Yuhang Wang, Zhengdu Ye, Christoph F. Dietrich, Jeong Min Lee, Kun Yan, Qiyu Zhao, Yan Shen, Xiaokun Hu, Luigi A. Solbiati, Jennifer Kuo, Giovanni Mauri, Jeong Yeon Cho, Jae Young Lee, Kaiwen Huang, Leonardo G. Rangel, Min Huang, Xiang Jing, Wen Cheng, Lianzhong Zhang, Hongyan Wang, Dong Xu, Jie Ren, Ronald S. Arellano, Yaqing Chen, Ligang Cui, Guangjian Liu, Qiang Lu, Kai Li, Desheng Sun, Zhiyi Peng, Danchen Gao, Wenyuan Shi, Ke Lv, Cheng Zhao, Shurong Wang, Lei Chen, Danxia Xu, Chao Cheng, Ying Huang, Guangbin He, Hong Yang, Lianfang Du, Liping Sun, Xinwu Cui, Weide Dai, Zubang Zhou, Qinying Li, Kaiyuan Shi, Ping Liang, Tian’an Jiang
Institutions: First Affiliated Hospital Zhejiang University, Hirslanden Klinik Beau-Site, Seoul National University, Seoul National University Hospital, Peking University Cancer Hospital, Zhejiang University, Affiliated Hospital of Qingdao University, Humanitas University, IRCCS Humanitas Research Hospital, Columbia University Irving Medical Center, Columbia University, Istituto Clinico Sant'Ambrogio, National Taiwan University, National Taiwan University Hospital, Universidade do Estado do Rio de Janeiro, Tianjin Third Central Hospital, Third Affiliated Hospital of Harbin Medical University, Henan Provincial People's Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Zhejiang Cancer Hospital, Sun Yat-sen University, Third Affiliated Hospital of Sun Yat-sen University, Massachusetts General Hospital, XinHua Hospital, Peking University Third Hospital, Sixth Affiliated Hospital of Sun Yat-sen University, Sichuan University, West China Hospital of Sichuan University, Peking University Shenzhen Hospital, Beijing Children’s Hospital, Shanghai Sixth People's Hospital, Sheng Jing Hospital, China Medical University, Xijing Hospital, First Affiliated Hospital of GuangXi Medical University, Shanghai Jiao Tong University, Shanghai First People's Hospital, Shanghai Tenth People's Hospital, Tongji Hospital, Huazhong University of Science and Technology, Beijing Hospital, Gansu Provincial Hospital, Anyang Hospital of Traditional Chinese Medicine, Chinese PLA General Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,190
OpenAlex ID: W7221969049
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