Venous malformations (VMs) are the most common vascular malformations. Multiple VMs are intramuscu- lar and can be located in specific areas such as the head and neck, trunk, and upper and/or lower limb.1,2
Intramuscular venous malformations (IMVMs) were identified years ago and were initially treated sur- gically.1 However, a number of surgical difficulties and frequent residual IMVM resulted in a change from the surgical approach to other treatment options such as medical management, or sclerotherapy, with or without surgical resection.
Most reports on IMVM1–3 have been based on a limited number of patients recruited over a long time and included IMVMs located in different areas. Thus, it is difficult to compare the outcomes of different treat- ment procedures.
Treatment options such as sclerotherapy and sur- gery should be chosen after considering symptoms, effectiveness, and risk. Sclerotherapy is a less invasive procedure,3 which is often effective for pain reduction, but less effective for muscle contracture.
IMVM located in the calf shows some particulari- ties: toe-walking due to equinus deformity, anatomical extension of VMs to cellular spaces, and the presence of ectasic tibial veins and/or soleus veins.