Fig. 1

Patient 1. a) Axial post contrast T2 weighted fat saturated MRI demonstrating a lobulated slow-flow vascular malformation in the posterior calf measuring 5.7 cm with fluid haematocrit levels (arrowhead) with dilated draining veins (arrow). b) Digital subtraction angiography did not reveal arterial inflow compatible with a slow-flow venous malformation. c) Venous phase of the angiogram showing venous pouch d) Digital subtraction venography showing retrograde venous access with 6Fr intermediate catheter (Sofia, Microvention, etc) (arrow) placed within the venous pouch (arrowhead). e) Arterial inflow was then controlled using a pressure cooker technique with inflation of a dual balloon catheter (Scepter C, Microvention, etc) (arrow). 6 ml sodium tetradecyl sulphate 3% was injected from the venous side with f) subsequent arteriogram confirming no evidence of arterial leak or distal embolization and successful occlusion of the venous malformation