Treating AVMs with rapamycine and bleomycine: about 3 cases

Abstract

Arteriovenous malformations (AVMs) are complex vascular
anomalies characterized by direct connections between dysplastic
arteries and dilated veins. They often present during
puberty or adulthood, most frequently in the head and
neck, and may cause complications such as pain, ulceration,
bleeding, or high-output cardiac failure. Conventional
management with embolization and surgery can be hazardous,
while novel biologics are not always accessible. We report
three cases of AVMs treated with a combined regimen
of systemic rapamycin and perilesional bleomycin injections.
The first patient, a 12-year-old girl with a breast AVM, achieved
sustained stability after two years of treatment and seven years
of follow-up. The second, a 31-year-old woman with a labial AVM,
showed complete and durable regression after three years of therapy
and six years of follow-up. The third, a 29-year-old woman
with a cheek AVM, experienced significant clinical and hemodynamic
improvement following two years of combined treatment,
after pregnancies had initially limited therapeutic options.
These cases highlight the efficacy and tolerability of rapamycin
plus bleomycin in controlling AVMs, avoiding disfiguring or
high-risk surgery. The findings suggest that this combination
may represent a valuable therapeutic option in settings
where embolization or advanced biologics are unavailable.