Sirolimus (Rapamycin) for Slow-Flow Malformations in Children

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Abstract
Vascular anomalies include a heterogeneous group of disorders divided into vascular tumors (characterized by vascular cell hyperplasia) and vascular malformations (due to defective embryologic vasculogenesis).1 Slow-flow vascular malformations include capillary malformations, venous malformations (VMs), lymphatic malformations (LMs), or combinations of these malformations. Several pathogenic, somatic, activating variants in the genes involved in vascular angiogenesis and lymphangiogenesis have been identified in vascular malformations, such as in PIK3CA (OMIM 171834) and TEK (OMIM 600221). PIK3CA variants have been identified mainly in combined vascular malformations associated with overgrowth, such as CLOVES (congenital lipomatous overgrowth, vascular malformations, epidermal nevis, spinal or skeletal anomalies or scoliosis) or Klippel-Trenaunay syndrome, but also in several cases of pure LMs and VMs,2-5 whereas TEK variants are more commonly found in VMs.6,7

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