Intravascular administration of absolute ethanol is the most effective treatment for vascular malformation. However, catastrophic cardiovascular collapse, although rare but fatal, may occurred during the procedure. At present, the clinical characteristics and pathogenesis of this fatal complication are still controversial. Vital aspects which may involved in the pathogenesis: pulmonary hypertension, pulmonary embolism, cardiac depression were reviewed. And the clinical characteristics of the reported cases, focusing on the timing, the dosage of ethanol, prediction and prevention were also reviewed systematically.