CardioVascular and Interventional Radiology

, Volume 41, Issue 10, pp 1505–1512 | Cite as

Intramuscular Venous Malformations of the Upper and Lower Limbs: Indications and Outcomes of Sclerotherapy

  • Giuseppe BianchiniEmail author
  • Daniele Camilli
  • Sergio Furgiuele
Clinical Investigation



Multiple treatment options have been described for intramuscular venous malformations (VMs) of the limbs. At the current time, there are no clear management guidelines. The aim was to evaluate efficacy and safety of sclerotherapy in this type of VMs.

Materials and Methods

This is a single-center, retrospective review of patients treated for extremity intramuscular VMs between January 2013 and June 2017. The primary outcomes were the improvement of symptoms self-assessed by questionnaires, and the reduction in VM size measured by magnetic resonance (MRI).


Sclerotherapy was performed in 81 patients with extremity intramuscular VMs. The sclerosing agent was ethanol in 46 cases (56.8%), polidocanol in 27 cases (33.3%), a combination of both in 8 cases (9.9%). The mean follow-up was 26 months (range 3–52). Overall quality of life was improved in 62 patients (76.5%). The postoperative MRI showed a minimum change of VM size in 68 patients (83.9%). A major complication (peripheral nerve injury) was observed in 1 case (1.2% of patients, 0.5% of procedures). Minor complications occurred in 9 cases (11.1% of patients, 4.1% of procedures).


Sclerotherapy is a low-invasive, effective and safe treatment for intramuscular VMs of the extremities. It induces a significant improvement in symptoms, also when the VM size is unchanged.

Level of Evidence

Level 4, Case Series.


Venous malformations Intramuscular Sclerotherapy 



We thank Dr Magenta Alessandra for the critical reading of the manuscript.

Compliance with Ethical Standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Greene AK, Liu AS, Mulliken JB, Chalache K, Fishman SJ. Vascular anomalies in 5621 patients: guidelines for referral. J Pediatr Surg. 2011;46:1784–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Wieck MM, Nowicki D, Schall KA, Zeinati C, Howell LK, Anselmo DM. Management of pediatric intramuscular venous malformations. J Pediatr Surg. 2017;52:598–601.CrossRefPubMedGoogle Scholar
  3. 3.
    Vogel SA, Hess CP, Dowd CF, Hoffman WY, Kane AJ, Rajaii R, Frieden IJ. Early versus later presentations of venous malformations: where and why? Pediatr Dermatol. 2013;30:534–40.CrossRefPubMedGoogle Scholar
  4. 4.
    Hassanein AH, Mulliken JB, Fishman SJ, Alomari AI, Zurakowski D, Greene AK. Venous malformation: risk of progression during childhood and adolescence. Ann Plast Surg. 2012;68:198–201.CrossRefPubMedGoogle Scholar
  5. 5.
    Mendonca DA, McCafferty I, Nishikawa H, Lester R. Venous malformations of the limbs: the Birmingham experience, comparisons and classification in children. J Plast Reconstr Aesthet Surg. 2010;63:383–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Hein KD, Mulliken JB, Kozakewich HP, Upton J, Burrows PE. Venous malformations of skeletal muscle. Plast Reconstr Surg. 2002;110:1625–35.CrossRefPubMedGoogle Scholar
  7. 7.
    Rivas S, Lopez-Gutierrez JC, Diaz M, Andrès AM, Ross Z. Venous malformations. diagnosis and treatment during the childhood. Cir Pediatr. 2006;19:77–80.PubMedGoogle Scholar
  8. 8.
    Jung HC, Kim DH, Park BK, Park MK. Extensive intramuscular venous malformation in the lower extremity. Ann Rehabil Med. 2012;36:893–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Domb BG, Khanna AJ, Mitchell SE, Frassica FJ. Toe-walking attributable to venous malformation of the calf muscle. Clin Orthop Relat Res. 2004;420:225–9.CrossRefGoogle Scholar
  10. 10.
    Gorriz E, Carreira JM, Reyes R, Gervàs C, Pulido JM, Pardo MD, Maynar M. Intramuscular low flow vascular malformations: treatment by means of direct percutaneous embolization. Eur J Radiol. 1998;27:161–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Rabe E, Pannier F. Sclerotherapy in venous malformation. Phlebology. 2013;28:188–91.CrossRefPubMedGoogle Scholar
  12. 12.
    Childs DD, Emory CL. Successful treatment of intramuscular venous malformation with image-guided radiofrequency ablation. J Vasc Interv Radiol. 2012;23:1391–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Cornelis FH, Labrèze C, Pinsolle V, Le Bras Y, Castermans C, Bader C, Thiebaut R, Midy D, Grenier N. Percutaneous image-guided cryoablation as second-line therapy of soft-tissue venous vascular malformations of extremities: a prospective study of safety and 6-month efficacy. Cardiovasc Intervent Radiol. 2017;40:1358–66.CrossRefPubMedGoogle Scholar
  14. 14.
    van der Vleuten CJ, Kater A, Wijnen MH, Schultze Kool LJ, Rovers MM. Effectiveness of sclerotherapy, surgery, and laser therapy in patients with venous malformations: a systematic review. Cardiovasc Intervent Radiol. 2014;37:977–89.PubMedGoogle Scholar
  15. 15.
    Cohen SR, Mount BM, Tomas JJ, Mount LF. Existential wellbeing is an important determinant of quality of life. evidence from the McGill quality of life questionnaire. Cancer. 1996;77:576–86.CrossRefPubMedGoogle Scholar
  16. 16.
    Goyal M, Causer PA, Armstrong D. Venous vascular malformations in pediatric patients: comparison of results of alcohol sclerotherapy with proposed MR imaging classification. Radiology. 2002;223:639–44.CrossRefPubMedGoogle Scholar
  17. 17.
    Yun WS, Kim YW, Lee KB, Kim DI, Park KB, Kim KH, Do YS, Lee BB. Predictors of response to percutaneous ethanol sclerotherapy (PES) in patients with venous malformations: analysis of patient self-assessment and imaging. J Vasc Surg. 2009;50:581–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Nakamura M, Osuga K, Maeda N, Higashihara H, Hamada K, Hashimoto N, Uehara S, Tomiyama N. Percutaneous sclerotherapy for venous malformations in the extremities: clinical outcomes and predictors of patient satisfaction. Springer Plus. 2014;3:520.CrossRefPubMedGoogle Scholar
  19. 19.
    Kim EY, Ahn JM, Yoon HK, Suh YL, Do YS, Kim SH, Choo SW, Choo IW, Kim SM, Kang HS. Intramuscular vascular malformations of an extremity: findings on MR imaging and pathologic correlation. Skeletal Radiol. 1999;28:515–21.CrossRefPubMedGoogle Scholar
  20. 20.
    Behravesh S, Yakes W, Gupta N, Naidu S, Chong BW, Khademhosseini A, Oklu R. Venous malformations: clinical diagnosis and treatment. Cardiovasc Diagn Ther. 2016;6:557–69.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lee BB, Baumgartner I, Berlien P, Bianchini G, Burrows P, Gloviczki P, Huang Y, Laredo J, Loose DA, Markovic J, Mattassi R, Parsi K, Rabe E, Rosenblatt M, Shortell C, Stillo F, Vaghi M, Villavicencio L, Zamboni P. Diagnosis and treatment of venous malformations consensus document of the international union of phlebology (IUP): updated 2013. Int Angiol. 2015;34:97–149.PubMedGoogle Scholar
  22. 22.
    Upton J, Coombs CJ, Mulliken JB, Burrows PE, Pap S. Vascular malformations of the upper limb: a review of 270 patients. J Hand Surg Am. 1999;24:1019–35.CrossRefPubMedGoogle Scholar
  23. 23.
    Stuart S, Barnacle AM, Smith G, Pitt M, Roebuck DJ. Neuropathy after sodium tetradecyl sulfate sclerotherapy of venous malformations in children. Radiology. 2015;274:897–905.CrossRefPubMedGoogle Scholar
  24. 24.
    Rautio R, Saarinen J, Laranne J, Salenius JP, Keski-Nisula L. Endovascular treatment of venous malformations in extremities: results of sclerotherapy and the quality of life after treatment. Acta Radiol. 2004;45:397–403.CrossRefPubMedGoogle Scholar
  25. 25.
    van der Linden E, Pattynama PM, Heeres BC, de Jong SC, Hop WC, Kroft LJ. Long-term patient satisfaction after percutaneous treatment of peripheral vascular malformations. Radiology. 2009;251:926–32.CrossRefPubMedGoogle Scholar
  26. 26.
    Qiu Y, Chen H, Lin X, Hu X, Jin Y, Ma G. Outcomes and complications of sclerotherapy for venous malformations. Vasc Endovascular Surg. 2013;47:454–61.CrossRefPubMedGoogle Scholar
  27. 27.
    Gurgacz S, Zamora L, Scott NA. Percutaneous sclerotherapy for vascular malformations: a systematic review. Ann Vasc Surg. 2014;28:1335–49.CrossRefPubMedGoogle Scholar
  28. 28.
    Teusch VI, Wohlgemuth WA, Hammer S, Piehler AP, Müller-Wille R, Goessmann H, Uller W. Ethanol-gel sclerotherapy of venous malformations: effectiveness and safety. AJR Am J Roentgenol. 2017;209:1390–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Chewning R, Lindberg A, Monroe E, Vaidya S, Shivaram G. Glue embolization of pediatric non-head and neck venous malformations. J Vasc Interv Radiol. 2016. Scholar
  30. 30.
    Steiner F, FitzJohn T, Tan ST. Ethanol sclerotherapy for venous malformation. ANZ J Surg. 2016;86:790–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Guevara CJ, Gonzalez-Araiza G, Kim SK, Sheybani E, Darcy MD. Sclerotherapy of diffuse and infiltrative venous malformations of the hand and distal forearm. Cardiovasc Intervent Radiol. 2016;39:705–10.CrossRefPubMedGoogle Scholar
  32. 32.
    Burrows PE. Endovascular treatment of slow-flow vascular malformations. Tech Vasc Interv Radiol. 2013;16(1):12–21.CrossRefPubMedGoogle Scholar
  33. 33.
    Asdahl KR, Hedelund L, Keller J, Baad-Hansen T, Damsgaard T. Outcome measures after sclerotherapy of venous malformations: a systematic review. Cardiovasc Intervent Radiol. 2018. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of Vascular Surgery, Center of Vascular AnomaliesIstituto Dermopatico dell’ImmacolataRomeItaly

Personalised recommendations