CIRSE Standards of Practice on Endovascular Treatment of Acute Pulmonary Embolism

PURPOSE: This CIRSE Standards of Practice document aims to provide comprehensive standards for the endovascular treatment of acute pulmonary embolism and includes recommendations for the imaging diagnosis, surveillance, intervention indications and endovascular treatments. METHODS: The CIRSE Standards of Practice Committee established a writing group of six internationally recognised interventional radiologists with expertise in pulmonary embolism interventions and one research assistant (C.I). The group conducted a pragmatic evidence-based PubMed search for relevant English-language reports on human subjects up to early 2025. The final recommendations are consensus-based. RESULTS: Endovascular treatment of pulmonary embolism is highly successful with low complication rates. For acute pulmonary thromboembolic disease, catheter-directed thrombolysis and mechanical thrombectomy are options for patients with intermediate-high-risk and high-risk pulmonary embolism, especially when systemic fibrinolysis fails or is contraindicated. CONCLUSIONS: Endovascular therapy for acute pulmonary embolism is both safe and effective. This best practice document emphasises early diagnosis, appropriate patient selection and timely intervention.