Successful Treatment of Complex Vascular Malformation with Sirolimus and Surgical Resection

Management of complex vascular malformation represents a challenge since it may include a wide variety of options such as embolization, laser therapy, sclerotherapy and surgical resection but may lead to significant morbidity and is associated to high recurrence rates. In extreme and/or recurrent cases, successful use of sirolimus has been described. We report a case of large unresectable complex vascular malformation treated with oral sirolimus for 24 months. Therapy was well tolerated. Patient had substantial improvement in symptoms and shrinkage of the lesion. Therapy made excision of malformation possible and patient was submitted to surgery.  This report provides further evidence that sirolimus should be considered part of the armamentarium in the management of these rare conditions.