Intramuscular Venous Malformations of the Upper and Lower
Limbs: Indications and Outcomes of Sclerotherapy
Received: 19 October 2017 / Accepted: 21 May 2018
Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe
Purpose 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, retrospec-
tive review of patients treated for extremity intramuscular
VMs between January 2013 and June 2017. The primary
outcomes were the improvement of symptoms self-asses-
sed by questionnaires, and the reduction in VM size mea-
sured by magnetic resonance (MRI).
Results 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).
Conclusions 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.
Keywords Venous malformations Á Intramuscular Á
Venous malformations (VMs) are the most common con-
genital vascular anomalies . They are located in skeletal
muscles in up to 40% of cases . Unlike skin VMs,
intramuscular VMs are generally not evident at birth but
manifest itself later in life . The intramuscular VMs of
the limbs may be highly symptomatic and show a pro-
gressive enlargement which induces a gradual worsening of
the symptoms [4, 5]. They typically present with pain and
swelling [3, 6, 7] and cause signiﬁcant functional limita-
tions [8, 9]. Consequently, the intramuscular VMs may be
disabling and require invasive treatment.
Multiple treatment options have been described: con-
servative management, sclerotherapy, surgery, laser ther-
apy and cryoablation [2, 6, 7, 10–14]. Anyway, no clear
management guidelines have been deﬁned at the current
The purpose of this study was to evaluate treatment
results and complications of sclerotherapy in intramuscular
VMs of the limbs.
& Giuseppe Bianchini
Department of Vascular Surgery, Center of Vascular
Anomalies, Istituto Dermopatico dell’Immacolata, Via dei
Monti di Creta 104, 00167 Rome, Italy
Cardiovasc Intervent Radiol