ô#and Francesco Stillo, MD ÃÃ Purpose: The aim of this study was to evaluate complications in patients with head and neck venous malformations (VMs) treated with foam sclerotherapy using sodium tetradecyl sulfate (STS). Methods: The authors retrospectively evaluated the complications, pain. and degree of satisfaction in 69 consecutive patients affected by cervicofacial VM managed with STS using the Tessari method in a single institution. Results: The average number of procedures for each patient was 2.1. The most frequent complication was blistering. We observed 1 patient of temporary weakness of a facial nerve branch, 1 paradoxical embolism, and 1 orbital compartment syndrome.The average pain score was 0 (no pain at all) (51.5%). There was no statistically significant correlation between patient satisfaction and the presence of complications or the degree of pain. Conclusions: Sclerotherapy with STS is an effective treatment that yields to very high patient satisfaction. This procedure has an overall low complication rate and is usually effective within a few sessions. However, severe complications may occur; these must be pointed out in the informed consent and the surgeon must be aware of and ready to quickly treat them to prevent long-term sequelae.Key Words: complication, endovascular, sclerotherapy, sodium tetradecyl sulfate, vascular malformation, venous malformation V ascular malformations are developmental abnormalities of the vascular tree present from birth. They are classified based on the vessel type (capillary, venous, lymphatic, and arteriovenous) or on their rheologic characteristics (slow-flow or fast-flow).1 Venous malformations (VMs) are the most common vascular malformation, and their treatment remains very challenging.2 Forty percent to 60% of all VMs involve the head and neck area. Symptoms may vary and include cosmetic complaints, pain, swelling, and functional limitations. Frequently, localized intravascular coagulopathy 3-5 can take place in larger VMs and will worsen signs and symptoms. In more ''benign'' patients, symptoms can be so mild that no treatment is needed, with the exception of conservative measures; in other patient, symptoms are so severe that >1 treatment can be needed and the approach has to be increasingly invasive. [6][7][8] There are several options to treat VMs and these include sclerotherapy, surgery, or laser. 9 Overall, many descriptive studies are present in the literature regarding sclerotherapy. However, most focus on technical procedural aspects or short-term results only. The conclusion in many articles is that VMs are difficult to treat and that most patients require multiple therapeutic sessions before a clinically relevant effect is obtained.Many sclerosants such as ethanol, jellified ethanol, bleomycin, polidocanol, or sodium tetradecyl sulfate (STS) are available, and they show an effectiveness of 74%, 89%, 88%, 90%, and 86%, respectively, according to a recent analysis. 6 Ethanol is one of the most commonly used, and is a potent agent for all types of va...