Intramuscular Venous Malformations Research Articles

Therapeutic evaluation and analysis of complications of ethanol sclerotherapy for intramuscular vascular malformations: a single-center retrospective study.

Intramuscular venous malformations (IMVMs) can cause pain and contracture deformity, leading to dysfunction of limbs. Ethanol sclerotherapy is one of the main treatments for IMVMs. This study aims to evaluate the efficacy and the complications associated with intravascular ethanol sclerotherapy for IMVMs and to provide a comprehensive summary of clinical experiences for future reference. A retrospective analysis was conducted on a cohort of 118 patients diagnosed with IMVMs who were treated with ethanol sclerotherapy in our center between 2006 and 2021. The plastic surgeons utilized a standardized collection pro forma to record the clinical data. Furthermore, a follow-up period ranging from 6 months to 5 years was implemented to assess the relief of symptoms, the change of lesion size, and the recovery of functional outcomes. In addition, an analysis of long-term complications was conducted. The clinical symptoms of the patients in this group included pain, swelling, and limited movement. On average, 5.61 mL (range 2-14 mL) of ethanol was used during the sclerotherapy procedure. The intraoperative and early postoperative complications were successfully relieved by means of timely intervention, as observed during the follow-up period. Based on the MRI results, the sizes of the lesions in 19% of the cases were significantly decreased, while a slight decrease was observed in 39% of the cases. During the follow-up period, it was found that only eight out of the 118 patients included in this study experienced long-term complications related to sclerotherapy. Although ethanol sclerotherapy has proven to be an effective first-line treatment for IMVMs, it is associated with a variety of adverse reactions and short- and long-term complications. Surgeons are required to perform operations prudently and provide timely medical intervention for postoperative complications.

The risk of muscle involvement in focal venous malformations in children.

Venous malformations (VMs) are the most common vascular malformations, which can be classified as focal, multifocal, or diffuse types. But the risk of focal venous malformations with muscle involvement is not well defined. This is a single-center, retrospective review of patients treated for focal VMs between February 2021 and February 2022. We assessed 26 patients focal VMs with 47 lesions; 18 (69%) were unifocal, 3 (12%) were dual-focal, and 5 (19%) were multifocal type VMs, and 29 (62%) were intramuscular VMs. The lower limbs intramuscular VMs had a significantly elevated risk of focal VMs (relative risk [RR],1.7; 95% confidence interval [CI], 1.148-2.394). Intramuscular involvement of the body should be considered in focal VMs. The lower limbs intramuscular VMs had a significantly elevated risk of focal VMs.

Characteristics, Natural Course and Treatment of Intramuscular Capillary-type Haemangioma: A Systematic Literature Review

Intramuscular capillary-type haemangiomas (ICTH) are rare vascular anomalies that can easily be misdiagnosed as other entities. A systematic review was performed of all cases of ICTH in the literature since its first description in 1972. An adjudication committee reviewed cases to include only ICTHs. Among 1,143 reports screened, 43 were included, involving 75 patients. The most frequent differential diagnosis was intramuscular venous malformations. The mean age of patients at diagnosis was 21.2 years. ICTH was mainly described as a gradually increasing mass (81.8%), painless (73.9%), that could occur anywhere in the body but most frequently on the head and neck (44.0%). Magnetic resonance imaging (MRI) was mainly used for diagnosis (69.1%) and displayed specific features. The most frequent treatment was complete surgical removal (73.9%), which could be preceded by embolization, and led to complete remission without recurrence in all but 1 case.

3D printing personalized guide plate in the management of recurrent intramuscular venous malformations: A single center experience.

This study aimed to investigate the feasibility and effectiveness of 3D printing personalized guide plate in the management of recurrent intramuscular venous malformations (IVM). Fifteen patients with recurrent IVM were retrospectively assessed. 3D-slicer software was used to extract and reconstruct the imaging data from CT and/or MRI to highlight the morphology, size, and puncture depth of the lesion. With the guidance of personalized plate, complete excision of the IVM was adopted along the pre-marked (methylene blue, MB) margin. Personalized guide plate matched involved extremity well, and MB-puncture approach was consistent with preoperative design. All IVMs were removed radically in one single session. Complete pain relief was obtained in all cases postoperatively. The application of 3D printing guide plate can be safe, effective, and reliable to confirming the precise margin of IVM, renders a promising technique with a high practical value in resection of recurrent lesion.

Factors Affecting Adverse Events after Venous Malformation Sclerotherapy

PurposeTo evaluate factors that contribute to adverse events (AEs) after embolization of venous malformations (VMs) using sclerosing agents. Materials and MethodsA retrospective review of patients who underwent direct puncture embolization of VMs with a sclerosing agent and adjunctive techniques, also termed as sclerotherapy, from 2016 to 2021 was performed. Three-hundred one embolizations in 137 patients (median age, 19.0 years; interquartile range, 12.8–31.5 years) were evaluated. The VM characteristics and embolization details were analyzed. Anticoagulation was also evaluated based on D-dimer levels. Cutaneous and noncutaneous AEs were analyzed. The AEs were categorized using Society of Interventional Radiology guidelines. ResultsVMs involving tissue planes were subcutaneous (n = 104), intramuscular (n = 84), and combined (n = 113). Overlying skin involvement was observed in 56% of the patients. Sodium tetradecyl sulfate was mainly used (83%). Periprocedural anticoagulation was used in 9% of the patients. Most AEs were minor (30/301, 9.7%), and only 1.7% (5/301) were major (21 cutaneous and 14 noncutaneous AEs). Age below 18 years (odds ratio, 4.4502; 95% confidence interval, 1.5607–12.6890; P = .0052) and overlying skin involvement (odds ratio, 7.1794; 95% confidence interval, 1.6226–31.7656; P = .0094) were factors associated with cutaneous AEs. All noncutaneous AEs developed in patients with intramuscular VMs; however, this association was not statistically significant. There was no severe hematologic AE or permanent consequence. ConclusionsThe overall AE rate after VM embolization was 11.6%; however, major AEs were rare (1.7%). Cutaneous AEs were associated with young age and overlying skin involvement. All noncutaneous AEs developed in patients with intramuscular VMs.

Effectiveness and safety of percutaneous sclerotherapy using absolute ethanol and/or polidocanol for maxillofacial venous malformations involving the masticatory muscles: A case series

This study evaluated the effectiveness and safety of percutaneous sclerotherapy for maxillofacial venous malformations. Patients who had venous malformations involving the masticatory muscles and who underwent sclerotherapy were enrolled in this retrospective study. Twenty-four patients (13 female, 11 male; mean age 21 years) were analyzed. Major clinical symptoms were swelling (100%) and intralesional pain (54%). Intramuscular lesions involved the masseter muscle only in 38% of cases, both the masseter and temporalis muscles in 33%, all masticatory muscles in 21%, and the temporalis muscle only in 8%. Extramuscular involvement was observed in 58% of patients. Absolute ethanol and polidocanol were used as sclerosants. The mean number of sclerotherapy sessions per patient was 6.6 (range, 1-32). The mean follow-up duration after the first sclerotherapy session was 64.8 months (range, 6-178). The complications included paralysis of the facial nerve (25%), intraoral ulceration (8%), and hemoglobinuria (8%). The effectiveness of treatment was rated as excellent in 33% of cases, good in 46%, and fair in 21%. Better results were obtained in patients without extramuscular involvement. Percutaneous sclerotherapy can be effective and safe for maxillofacial intramuscular venous malformations, especially for localized lesions of the masseter muscle.

Treatment of venous malformations with tumescent-assisted sclero-embolic and ablative lasers (SEALs): Safe and effective long-term outcomes.

Perivascular infiltration of tumescent anaesthesia (TA) is an essential element of endovenous thermal ablative procedures employed to treat superficial venous disease. In addition to anaesthesia, TA is administered to achieve vessel wall approximation and to protect surrounding structures from thermal damage. However, its role in the treatment of venous malformations (VMs) has not been established. To assess the safety and efficacy of tumescent-assisted thermal and chemical ablative methods in the treatment of VMs. Adult and paediatric patients presenting with VMs were treated using a combination of endovenous laser ablation, foam embolo-sclerotherapy and liquid embolisation using n-BCA. All procedures were ultrasound-guided. Treatment outcomes were assessed in early and late follow-ups. To assess the efficacy of TA in achieving vessel wall approximation, cross-sectional lesional diameters were measured by ultrasound, before and after the administration of TA during endovenous procedures. In a 12month period, 22 patients recruited in the study presented with 27 VMs which included 23 extra-truncular lesions (16 subcutaneous and seven intramuscular) and four truncular anomalies. On average the subcutaneous lesions measured 5.5mm (1.9-24.5mm) in diameter, intramuscular lesions measured 9.2mm (5.9-15.1mm) and truncular anomalies measured 4.9mm (1.2-12mm) in diameter. Perivascular infiltration of TA resulted in a significant reduction in vessel calibre (90% reduction on average). Intramuscular VMs were less compressible with TA (69.2% reduction) compared to subcutaneous lesions (98% reduction). Truncular anomalies such as the embryonic marginal vein achieved complete approximation (100% reduction). Procedures were safely tolerated with no major complications such as thromboembolism, stroke, nerve damage or tissue necrosis. Most patients had significant clinical as well as ultrasonographic improvement. Tumescent-assisted endovenous laser ablation and foam sclerotherapy provides safe and effective outcomes in patients with a variety of VMs.

The effects of surgical treatment and sclerotherapy for intramuscular venous malformations: a comparative clinical study.

BackgroundVenous malformations (VMs) are the most common type of vascular malformations. Intramuscular venous malformations (IMVMs) are lesions involving the muscles, excluding intramuscular hemangiomas. The purpose of this study was to compare clinical outcomes between patients with IMVMs who were treated with sclerotherapy and those who were treated with surgical excision.MethodsOf 492 patients with VMs treated between July 2011 and August 2020 at a single medical center for vascular anomalies, 63 patients diagnosed with IMVM were retrospectively reviewed. Pain, movement limitations, swelling, and quality of life (QOL) were evaluated subjectively, while radiological outcomes were assessed by qualified radiologists at the center. Complication rates were also evaluated, and radiological and clinical examinations were used to determine which treatment group (sclerotherapy or surgical excision) exhibited greater improvement.ResultsAlthough there were no significant differences in pain (P=0.471), swelling (P=0.322), or the occurrence of complications (P=0.206) between the two treatment groups, the surgical treatment group exhibited significantly better outcomes with regard to movement limitations (P=0.010), QOL (P=0.013), and radiological outcomes (P=0.017). Moreover, both duplex ultrasonography and magnetic resonance imaging showed greater improvements in clinical outcomes in the surgical excision group than in the sclerotherapy group.ConclusionsAlthough several studies have examined IMVM treatment methods, no clear guidelines for treatment selection have been developed. Based on the results of this study, surgical excision is strongly encouraged for the treatment of IMVMs.

Ultrasound-guided percutaneous endovenous laser treatment combined with sclerotherapy for the treatment of large intramuscular venous malformations.

Among vascular anomalies, congenital venous malformations (VMs) are the most common lesions. Treatment of VMs is sometimes difficult or cumbersome, depending on their size and tissue involvement. Surgery may lead to invasive and mutilating excisions, often allowing only partial removal, with an increased risk of recurrence. Sclerotherapy is a mainstream technique, resulting in endothelium destruction, fibrosis and subsequent shrinkage of the vascular lesion, also with a risk of recurrence. However, this technique may not be efficient in cases of large and infiltrating VMs. Endovenous thermal ablation has been found to be more effective than sclerotherapy for transmural vascular destruction and has therefore been employed in the treatment of VMs. In this study we described a combined technique for the treatment of large intramuscular VMs in seven consecutive patients, associating endovenous laser ablation with sclerotherapy. The aim was to assess feasibility and safety of the procedure. We reported a high immediate technical success, clinical and radiological improvement, with no complications. The preliminary results presented herein show, that combining EVLA and sclerotherapy for the treatment of voluminous persistent intramuscular VM is safe and technically feasible. The combination of a wide direct intimal thermal damage with chemical sclerotherapy is the force of this approach. The small number of cases and the medium term follow up represent though a limitation.

Quality of life and clinical results after endovascular sclerotherapy: A comparison between intra- and extramuscular low-flow venous malformations.

Based on clinical observations we hypothesized that patients with intramuscular venous malformations (VMs) did worse or needed more sclerotherapy sessions than patients with extramuscular VMs. To evaluate the difference in treatment and quality of life (QOL) results after Polidocanol sclerotherapy of intra- and extramuscular low-flow VMs. Forty-one patients with a VM were treated with Polidocanol in two university hospitals. The results were retrospectively analyzed. Pre- and post-treatment magnetic resonance imaging (MRI) scans were compared. All patients completed a self-evaluating form on symptoms as well as a QOL questionnaire. The results were compared between two groups: intra- and extramuscular VM's. No statistically significant differences between intra- and extramuscular groups concerning QOL and specific dimensions pain, functional problems or cosmetic appearance were found. Radiological changes in MRI examinations did not correlate with any of the subjective symptoms. 56% of the patients benefitted from the treatment according to patient self-evaluation. In this material intramuscular VM's responded to the treatment comparably to extramuscular malformations. Post-treatment MRI findings do not correlate with subjective symptoms or QOL results and thus, a routine post-treatment examination seems to be unwarranted. Subjective symptoms and QOL results are the most important parameters in evaluating the effectiveness of sclerotherapy.

Surgical Management of Intramuscular Venous Malformations.

Intramuscular venous malformations, often erroneously called "intramuscular hemangiomas," present to pediatric orthopaedic surgeons either as a differential diagnosis of tumor or as a cause of muscle pain. Treatment options include injection sclerotherapy or surgery. There is some literature to indicate that sclerotherapy can reduce pain, but little evidence on the effectiveness of surgery. The primary aim of this study was to evaluate the efficacy of surgical resection for intramuscular venous malformations, with a secondary aim to evaluate the natural history and presentation of intramuscular venous malformations to improve clinician understanding of this condition. A retrospective chart analysis was performed of cases identified from a vascular anomalies database from January 2004 and December 2018. Primary outcome was change in preoperative and postoperative pain. Natural history of the lesion was assessed, including age when the lesion was first noticed, when it became painful, and when it required treatment. Fifty-four cases were identified in the study period of which 40 underwent surgery. Pain improved in 36 of 39 patients (92.3%) who had pain before surgery and 29 (74.4%) were pain free after surgery. All 13 patients who required whole muscle excision to resect the lesion experienced an improvement in pain and 10 (76.9%) were pain free. A history of previous intervention, with surgery or sclerotherapy showed a trend towards less successful surgical outcomes. Patients presented across a wide age range from infancy to adulthood, but the most common presentation was pain with exercise between 9 and 16 years of age, with presence of a mass in about half of cases. Surgery, when performed by a surgeon with appropriate experience, is an effective first-line treatment for painful intramuscular venous malformations, offering pain relief in the majority of cases. Magnetic resonance imaging and ultrasound are diagnostic in most cases. The majority of lesions are resectable, meaning they can be removed with a margin leaving a functional limb. Sometimes resection of a whole muscle is required. Level IV-case series.

Intramuscular venous malformations of the calf: Surgical treatment outcomes of 57 patients.

To report the outcomes of surgical treatment of calf intramuscular venous malformations (IMVMs) on pain, functional limitation, and quality of life. We retrospectively reviewed 57 consecutive patients who had surgery for IMVM of the posterior compartment of the leg between 2010 and 2015. Treatments were all done at a single institution. Patients presented with pain (52), muscle contracture (14), or pulmonary embolism (4). Muscle involvement included the soleus muscle (n = 28, 49%), the gastrocnemius muscle (n = 25, 43%), and deep muscles (n = 4, 7%). Complete excision was possible in 52 patients (91%) and partial excision in 5 (9%). Thirty-five of 46 patients who had an MRI follow-up at six months had no residual venous malformation. At the final follow-up (mean 39 months), 32 of 40 patients seen had no residual pain and 37 had no residual functional impairment. In cases where IMVM is located in one muscle in the leg, we demonstrated that surgery yielded improvement in pain, function, and quality of life.

Percutaneous Cryoablation of Symptomatic Intramuscular Venous Malformation

PurposeTo evaluate the efficacy and safety of cryoablation for venous malformations. Materials and MethodsA total of 12 patients with symptomatic intramuscular venous malformations who underwent percutaneous cryoablation between February 2015 and December 2018 were retrospectively studied. The mean age was 42 y (range, 19–58 y). Pain was reported by 11 patients (92%) and swelling by 1 (8%). Pain was assessed with a visual analog scale (VAS) before and after cryoablation. Lesion size was followed with magnetic resonance (MR) imaging at baseline and at 3-mo follow-up. Median initial VAS score was 7 (range, 0–8), and median initial lesion size was 32.5 mm (range, 11–150 mm). ResultsThe median VAS score at 3 mo was 0 (range, 0–4), and the median lesion size at 3 mo was 0 mm (range, 0–142 mm). Eleven of 12 patients reported an improvement in their pain. MR imaging control showed a treatment scar with no residual lesion in 5 patients and decreased lesion size in 4. No major complications were reported. One minor hematoma and 1 small myositis were noted as defined by Society of Interventional Radiology criteria. ConclusionsPercutaneous cryoablation is effective and safe for treatment of symptomatic intramuscular venous malformations, with improvement of symptoms.

Spectrum of imaging findings in Klippel-Trenaunay syndrome affecting lower limbs: a report of three cases

BackgroundWe present a series of three cases of Klippel-Trenaunay syndrome (KTS) presenting with unilateral lower limb involvement demonstrating a wide range of radiological findings.Case presentationCase 1: A 61-year-old male presented with varicosities in the right lower limb, which was atrophic with a complete absence of deep venous system in the right limb. Case 2: A 23-year-old woman presented with hypertrophied left lower limb with multiple varicosities showing unusual distribution and intraosseous extension into the distal femur, patella, and tibia. Case 3: A 14-year-old male presented with hypertrophy of the right lower limb overlying macular cutaneous lesions. Capillary malformation was seen underneath the cutaneous lesion and multiple subcutaneous and intramuscular venous malformations were seen. Also noted was persistent embryological vein, i.e., lateral marginal vein of Servelle.ConclusionThe three cases in our series demonstrate common and unusual findings of KTS and highlight the role of CT and MR venography in addition to color Doppler sonography to identify the complete extent of the involvement.

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

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. 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 26months (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 4, Case Series.

Sclerotherapy for intramuscular vascular malformations: A single-center experience

BackgroundVascular malformations isolated to skeletal muscles are rare and often debilitating due to pain and very challenging to treat. Multi-modal management options include compression garments, medical therapy, sclerotherapy, and surgical resection. MethodsA retrospective review of patients who underwent sclerotherapy for intramuscular venous malformations (IVM) between 2008 and 2016 was performed. Demographics, indications, and clinical follow-up were analyzed. ResultsTwenty patients underwent sclerotherapy for IVM. Six males and 14 females underwent 58 procedures. All patients presented with pain and were treated initially with compression garments. Median age at first treatment was 13years (+/− 5.06years). Initial protocol consisted of 2 sclerotherapy procedures with sodium tetradecyl sulfate (STS) within a 2–3month interval. Median volume of the lesion was 40cm3 (+/− 28.7), mostly located in the lower extremities (15/20). Median number of treatments was 2 (+/− 1.95). Treatment prior to puberty resulted in a median symptom-free time of 4years (+/− 2.18), while after puberty resulted in a symptom-free time of 2years (+/− 2.28). Two patients had an underlying coagulopathy and were admitted for observation and peri-procedural Lovenox. No procedure related complications were noted with a median follow-up of 4years (+/− 2.27). ConclusionIVMs are rare but can be incapacitating secondary to pain. Sclerotherapy is a useful minimally invasive procedure generally requiring at least two consecutive treatments. Treatment of patients prior to puberty appears to provide a more durable result, and surgical resection may be avoided. Type of studyretrospective. Level of evidenceIV

Intramuscular venous malformations of the lower limbs: Results of the surgical treatment of 57 patients

The place of resective surgery to treat intramuscular venous malformations (VM) is still debated because of the risk of functional sequelae. A homogeneous cohort of intramuscular (IM) (MV) of the posterior compartment of leg was studied in order to evaluate this risk. The purpose of the study was to evaluate the benefit of the surgery in terms of pain, function of the member and quality of the life. This was a retrospective, observational, monocentric study.

Multiple Low Flow Vascular Malformation with Phleboliths – A Case Report

: Objective: Venous malformation involving head and neck region is a rare entity. Hence, application of precise and leading diagnostic techniques, gives the accurate localization of the source vessel allowing for making treatment plan more satisfactory. Methods: We present a case of 30-year-old male patient with venous malformation involving head and neck region. We update the review of literature and also discuss the leading diagnostic aids for this rare entity disease so that iatrogenical accidents can be lessened. Case description: Our patient presented with solitary swelling in the left lower cheek region, left side of lateral border of tongue and 2 – 3 small nodular swellings at the lateral border of the neck, lined obliquely over the sternocleidomastoid muscle. All the swellings were soft in consistency and non-tender, with no rise in temperature except for the swelling on the tongue. The lesion was confirmed by a radiograph which showed phleboliths. The ultrasound shows heterogeneously hypoechoic with multiple anechoic sinusoidal spaces (longitudinal plane) with mild vascularization and spectral analysis shows monophasic venous flow. This was later confirmed by direct puncture venography of the left cheek. Conclusion: The spectrum of vascular malformations is too vast; hence it becomes challenging to diagnose the lesion and fit it in the spectrum. These lesions are termed as intramuscular venous malformations based on clinical imaging and pathologic criteria and hence dentists must be aware of the clinical expression of these lesions in order to prevent iatrogenically related accidents and to minimize potential spontaneous crises for the patient. Having said that and keeping in mind the broad spectrum of vascular malformation, we present a clinically well diagnosed case of venous malformation, which illustrates phleboliths.Key words: Venous malformations (VMs), Arteriovenous malformation (AVM), Phleboliths, sclerotherapy, Venography and Hemangioma.

Angiomatosis of soft tissue as an important differential diagnosis for intramuscular venous malformations.

Background We aimed to improve management of extremity low-flow vascular malformations by analyzing the histology and imaging of venous malformations (VMs) not responsive to sclerotherapy. Method We reviewed patient records of 102 consecutive patients treated with sclerotherapy for extremity VM in our institution to identify patients who had undergone surgery due to insufficient response. We semi-quantitatively analysed the tissue specimens and compared histological findings to those in preoperative imaging. Result The number of patients operated on was 19 (18.6%); 15 of them had lower-extremity intramuscular lesions. The histological pattern of 13 of these 15 lesions corresponded to angiomatosis of soft tissue (AST). All other lesions treated surgically were VMs. The histology of AST was distinctive but magnetic resonance imaging findings often overlapped with those of VM. Conclusion AST is easily mixed with intramuscular VM. The differentiation of these two entities has therapeutic importance. We emphasize the role of histology in the differential diagnostics of intramuscular slow-flow vascular malformations.

Management of pediatric intramuscular venous malformations

BackgroundIntramuscular venous malformations (VMs) are rare, but can be highly symptomatic. There are few reports on outcomes, particularly pain, functional limitations, and muscle contractures. We aimed to compare results of medical management, sclerotherapy, and surgical resection. MethodsWe retrospectively reviewed 45 patients with an extremity or truncal intramuscular VM between June 2005 and June 2015 at a single institution. Outcomes were compared between treatment modalities with ANOVA and χ2 tests. ResultsSix patients (13%) were treated with medical management, 4 (9%) with surgical resection, 23 (51%) with sclerotherapy, and 12 (27%) with both surgery and sclerotherapy. Sclerotherapy alone decreased pain in 72%. Only 20% of patients presented with muscle contracture. For these patients, 33% resolved with sclerotherapy, physical therapy, and aspirin; 22% resolved with surgery, and 45% had persistent contracture. 40% of patients treated with sclerotherapy then surgery developed new muscle contractures, compared to 4% of sclerotherapy only patients and 0% of surgery only patients (p=0.04). ConclusionsMedical management, surgery and sclerotherapy are effective treatments for intramuscular VMs. Observation and supportive care can be a primary treatment for patients with minimal symptomatology and no functional limitations. Sclerotherapy is more effective for treating pain than contractures and when used alone, rarely causes a new muscle contracture.