The Proposal of the Concept of “Watershed Vascular Embolization” and Its Clinical Application and Significance in Vascular Interventional Therapy

Transarterial embolization and infusion therapy are foundational interventions for conditions including hemorrhage, vascular malformations, and benign/malignant tumors. However, the prevailing nomenclature for these procedures (e.g., “hepatic arterial infusion chemotherapy”, “bronchial artery embolization, BAE”) suffers from a fundamental limitation: naming conventions based on a single target artery conceptually constrain the therapeutic objective, overlooking the pathological reality that lesion perfusion is sustained by a dynamic, three-dimensional network of multiple arterial sources and collateral channels. This cognitive bias is a common underlying cause of high postoperative recurrence rates, suboptimal efficacy, and complications such as non-target embolization. To address this systemic issue, this paper introduces a universal new theory—“watershed vascular embolization”—based on vascular anatomy, hemodynamic principles, and clinical practice. This theory defines the complete functional blood supply unit of a lesion as a “watershed vascular”, advocating for a shift in therapeutic focus from occluding individual vessels to managing the entire dynamic perfusion network. Using conventional BAE as a paradigm, this article elaborates the conceptual framework and clinical significance of watershed vascular embolization, aiming to reshape interventional thinking and provide a novel theoretical paradigm and practical guidance for enhancing the thoroughness, safety, and long-term outcomes of vascular intervention.