Prevention and management of bleeding complications in interventional ultrasound: an international expert consensus statement

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.

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Journal
BMC Medicine
Published
2026-10-14
DOI
https://doi.org/10.1186/s12916-026-05315-8
Primary Topic
Ultrasound in Clinical Applications
Type
article
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article

Prevention and management of bleeding complications in interventional ultrasound: an international expert consensus statement

Tianan Jiang, HE Guangbin, Lianfang Du, Leonardo Guimarães Rangel et al.
BMC Medicine
Ultrasound in Clinical Applications
article

Prevention and management of bleeding complications in interventional ultrasound: an international expert consensus statement

Tianan Jiang, HE Guangbin, Lianfang Du, Leonardo Guimarães Rangel, Christoph Frank Dietrich, Danchen Gao, Zhengdu Ye, Ronald S. Arellano, Jennifer Hong Kuo, Hong Yang, Xiang Jing, Min Xu, Wen Cheng, Kun Yan, Kai Li, Min Huang, Dai Weide, Ping Liang, Zubang Zhou, Cheng Zhao, Giovanni Mauri, Yan Shen, Ligang Cui, Luigi Solbiati, Chao Cheng, Qiyu Zhao, Wenyuan Shi, Kaiwen Huang, X W Cui, Jie Ren, Kaiyuan Shi, Ke Lv, Jeong Min Lee, Guangjian Liu, Yuhang Wang, CHEN Yaqing, Ying Huang, Hongyan Wang, Lei Chen, Shurong Wang, Liping Sun, Jeong Yeon Cho, Danxia Xu, Lianzhong Zhang, Zhiyi Peng, Qinying Li, Qiang Lu, Desheng Sun, Jae Young Lee, Dong Xu, Xiaokun Hu
article en

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.

BMC Medicine
Humanitas University (IT), Seoul National University (KR), Sun Yat-sen University (CN), National Taiwan University (TW), Shanghai Jiao Tong University (CN), Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Sichuan University (CN), Columbia University Irving Medical Center (US), Sheng Jing Hospital (CN), Peking Union Medical College Hospital (CN), XinHua Hospital (CN), Seoul National University Hospital (KR), Chinese PLA General Hospital (CN), Universidade do Estado do Rio de Janeiro (BR), Massachusetts General Hospital (US), Tianjin Third Central Hospital (CN), West China Hospital of Sichuan University (CN), Sixth Affiliated Hospital of Sun Yat-sen University (CN), Peking University Cancer Hospital (CN), Zhejiang Cancer Hospital (CN), Hirslanden Klinik Beau-Site (CH), Istituto Clinico Sant'Ambrogio (IT), Third Affiliated Hospital of Harbin Medical University (CN), Gansu Provincial Hospital (CN), Affiliated Hospital of Qingdao University (CN), Beijing Hospital (CN), First Affiliated Hospital of GuangXi Medical University (CN), Peking University Shenzhen Hospital (CN), National Taiwan University Hospital (TW), Shanghai Tenth People's Hospital (CN), Henan Provincial People's Hospital (CN), Shanghai First People's Hospital (CN), Peking University Third Hospital (CN), Beijing Children’s Hospital (CN), Shanghai Sixth People's Hospital (CN), Third Affiliated Hospital of Sun Yat-sen University (CN), Xijing Hospital (CN), Tongji Hospital (CN), IRCCS Humanitas Research Hospital (IT), First Affiliated Hospital Zhejiang University (CN), Anyang Hospital of Traditional Chinese Medicine (CN), Huazhong University of Science and Technology (CN), Zhejiang University (CN), Columbia University (US), China Medical University (CN)
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Ultrasound in Clinical Applications
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