Purpose : To investigate the usefulness of carbon dioxide digital subtraction angiography ($CO_2$-DSA)in direct puncture sclerotherapy of venous hemangiomas involving extremities.Materials and Methods : Direct puncture sclerotherapy was performed in 12 patients with venous hemangioma of extremities. After direct puncture of the venous hemangiomas, 30-50cc of $CO_2$was manually injected and digital subtraction angiograms were obtained. If draining vein was visualized, a tourniquet was applied at the proximal site to compress the draining veins. Thereafter, radiopaque embolic materials such as 1 : 3 mixture of Lipiodol and absolute ethanol or ethanolamine oleate-Lipiodol-Avitene(microfibrillar collagen hemostat) mixture were slowly injected under the fluoroscopic guidance.Results : Rapid injection of large amount of $CO_2$enabled the visualization of wide areas of venous hemangiomas in 11 patients. Draining veins were reliably demonstrated in 10 patients and pulmonary embolism of embolic materials was effectively prevented by proximal tourniquet application. Because of radiolucent nature of $CO_2$retained in hemangiomas, we could clearly identify the distribution of radiopaque embolic materials under fluoroscopy. Retained $CO_2$also could be used as a guide for additional multiple puncture of hemangiomas. There was no systemic symptoms or complications related to $CO_2$-DSA.Conclusion : $CO_2$-DSA is a convenient, safe and useful angiographic technique in direct puncture sclerotherapy of hemangiomas involving extremities.