The 2025 update of the ISSVA classification of vascular malformations introduces an expanded and clinically oriented framework for the categorization of congenital vascular anomalies. Beyond the traditional subdivision into “slow-flow” and “fast-flow” malformations, the revised system integrates genetic, hemodynamic and clinical parameters. For the most common entity, simple venous malformations, whether isolated or multifocal, treatment planning requires particular attention to drainage patterns (Puig types I–IV) and to the recently refined phlebographic subtyping (phlebectatic vs. spongiform). These distinctions have immediate therapeutic implications: while type I–II VMs can generally be treated safely with sclerotherapy, types III–IV are associated with a higher risk of complications and therefore demand a more cautious approach. - Updated Classification of Vascular Anomalies. Journal of Vascular Anomalies June 2025, Volume 6, Number 2 - A proposal for a revision of the phlebographic classification of congenital venous malformations. Cardiovasc Diagn Ther 2024;14(2):283-293