In 1986, Dr. Yakes et al described curative treatment for the first time of a massive extremity and pelvis AVM with 98% Ethyl alcohol or ethanol. Since then, it has become increasingly apparent that ethanol embolotherapy for vascular malformations of all types can be curative, especially for large complex AVMs that surgery or other embolization treatments are impossible to manage. Ethanol is a powerful sclerosing agent that denatures blood proteins and destroys the endothelial cells in the vessel wall effectively destroying the abnormal vascular mass and preventing its ability to regenerate. Ethanol is injected either by direct puncture techniques, via a very small catheter which is directed in to the malformation itself, or through a catheter which is inserted within a vessel leading to the malformation. Typically, vascular malformations require serial treatments to cure. In those patients with pain syndrome, serial devascularization of the malformation will usually reduce the amount of pain the patient suffers. After serial therapy, MRI can be used to document the efficacy of therapy.