Objective To investigate the clinical effect of radiofrequency ablation (RF) combined with digital subtraction angiography (DSA)-guided percutaneous ethanol injection sclerotherapy in the management of high-return flow venous malformation (VM).Methods Forty-one patients,who were diagnosed as high-return flow VM with clinical and radiographic evidence,were divided into the observation group (n=19) and the control group (n=22) using a random number table.All high-return flow VM patients received DSA-guided percutaneous ethanol injection sclerotherapy while the patients in observation group were given radiofrequency ablation.The clinical effect,treatment times and adverse effect of the two groups were analyzed.Results The effectiveness of the observation group was significantly higher than those of the control group [94.7％ (18/19) vs 81.8％ (18/22)].The facial paralysis occurred in three patients (13.6％) after ethanol injection in the control group,while the observation group had no facial nerve injury after treatment.The patients in observation group had significantly fewer numbers of ethanol injection.Conclusions RF can improve the efficacy of high-return flow VM and reduce the number of ethanol injection.The scheme is safe and effective.