Intraosseous Venous Malformation of the Distal Fibula Treated with Image-Guided Sclerotherapy and Embolization

Intraosseous venous malformations (IOVMs) are rare slow-flow vascular lesions in which involvement of lower-extremity long bones is uncommon. A 51-year-old woman with antithrombin III deficiency and post-thrombotic syndrome presented with focal left leg pain initially attributed to chronic venous disease. CT venography demonstrated a serpiginous intraosseous lesion within the distal fibula communicating with the peroneal venous system. Image-guided selective embolization was performed using foam sclerotherapy and n-butyl cyanoacrylate. Post-procedural imaging confirmed exclusion of the lesion. At follow-up, the patient reported resolution of focal bone pain without radiographic recurrence. This case illustrates diagnostic considerations and technical management of symptomatic lower-extremity IOVMs.