The patient is a male, 48 years old, with extensive venous malformations of the perineum, left hip, and left lower extremity, and has been treated in several hospitals around the country. In one of them, he underwent radiation therapy on the lateral and plantar aspect of the left foot in a hospital (venous malformations cannot be treated with radiation therapy, so I wonder why that hospital performed radiation therapy?) After CTA and DSA examination, it was decided to select the dorsalis pedis artery and the accompanying veins as the anastomotic vessels for the recipient area. The procedure went smoothly. One day after the operation, a venous crisis occurred, and he was rushed to the hospital (he was playing with his son at the science museum) to re-explore and re-anastomose the vein. After the anastomosis, the edge of the flap was partially necrotic, and it finally healed after 2 months of medication changes. Looking back on the treatment process, it was quite arduous. Although the radioactive ulcer of the left foot was treated, the extensive venous malformation of the perineum, hip and lower extremity was not treated. I can’t say that I feel much accomplishment, but actually I feel quite helpless. There is no curative treatment for such an extremely extensive venous malformation, sclerotherapy? Copper wire placement? We can only partially control the lesion, not cure it. The patient was treated in many hospitals all over the country and lost his confidence with incorrect or even downright wrong treatment. Body surface soft tissue venous malformations are the most prevalent vascular malformations, and their treatment urgently needs to be standardized. A few hospitals, especially some private so-called hemangioma specialist hospitals, are all for profit and administer some obviously inappropriate treatments to patients, hoodwinking and deceiving them, delaying their conditions and making them unmanageable. Therefore, it is the joint responsibility of the medical administration and clinicians to formulate scientific and reasonable guidelines for the standardized treatment of soft tissue venous malformations and promote them nationwide based on the current evidence-based medical evidence. In this way, timely and reasonable treatment is provided to patients to control the development of lesions, improve the cure rate, and avoid similar dilemmas as this patient. Happily, the pathogenesis of venous malformation has been largely clarified (Tie-2 gene mutation) and animal models of venous malformation have been successfully produced (transplantation of HUVECs carrying Tie-2 gene mutation into nude mice). Experimental studies and clinical observations have confirmed the therapeutic effect of rapamycin on venous malformations, which is undoubtedly a hope for patients with severe venous malformations mentioned above.