Surgical treatments can be used to remove the mass of the venous malformation. Although surgery can be quite effective it is often difficult to separate the venous malformation from the surrounding nerves and other important tissues. It can be hard to get the tissues to heal well if the edges contain venous malformation. It does have the advantage that very large areas can be treated at a single treatment. A small needle is placed directly into the venous malformation.
Radiographic contrast is injected in the lesion and watched under X-ray.
This is called a venogram. After it is determined that the contrast does not go to any critical structures, contrast laden absolute ethanol is injected, again while monitoring this under fluoroscopy. When this area of the lesion has been fully treated, the ethanol-contrast mixture is seen going to other areas, or the skin over the lesion looks ischemic, the injection is stopped and another area is treated. Sclerotherapy is a in-patient procedure that requires general anesthetia. The ethanol gives a chemical burn to the inside of the blood vessel.