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Features include always present findings: Capillary malformation; and rarely findings: Vein of Galen aneurysmal malformation. 3 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Skin | 1 | Telangiectasia |
EPHB4 encodes EPH receptor B4 (987 aa). Receptor tyrosine kinase which binds promiscuously transmembrane ephrin-B family ligands residing on adjacent cells, leading to contact-dependent bidirectional signaling into neighboring cells. Highest expression in Uterus (133.8 TPM) and Cervix Endocervix (110.2 TPM).
Capillary malformation-arteriovenous malformation 2 is associated with mutations in the EPHB4 gene on chromosome 7.
EPHB4 is classified as a druggable target (Clinically Actionable, Druggable Genome, Enzyme, Kinase, and Tyrosine Kinase categories) with score 5.4.
Diagnostic criteria for capillary malformation-arteriovenous malformation (CM-AVM) syndrome have been proposed but not systematically evaluated .
CM-AVM syndrome should be suspected in probands who have any of the following:
Source: GeneReviews — "Capillary Malformation-Arteriovenous Malformation Syndrome"
No approved treatments are currently available for capillary malformation-arteriovenous malformation 2. The disease remains an area of unmet medical need.
Evaluations Following Initial Diagnosis To establish the extent of disease and needs of an individual diagnosed with capillary malformation-arteriovenous malformation (CM-AVM) syndrome, the following evaluations (if not performed as part of the evaluation that led to the diagnosis) are recommended: • Medical history and physical examination with a focus on symptoms and findings secondary to arteriovenous malformations/arteriovenous fistulas (AVMs/AVFs) • Brain imaging – if not already performed – to identify AVMs/AVFs (e.g., vein of Galen aneurysms and other intracranial AVMs) to allow early identification of macrofistulas that can be treated prior to the development of symptoms • Consideration of spine imaging to identify and characterize AVMs/AVFs. Currently no consensus protocols for radiographic evaluation of individuals with CM-AVM syndrome have been developed; therefore, discussion with a radiologist is recommended in order to develop an appropriate plan for imaging based on the patient's age and the capabilities and experience of the imaging facility. • Consideration of further imaging in individuals with evidence of cardiac overload, to look for causative AVMs/AVFs • Evaluation for evidence of epistaxis (nosebleeds), and if present, referral to otolaryngologist as appropriate. If epistaxis is present, consider complete blood count for evaluation of anemia. • Consultation with a clinical geneticist and/or genetic counselor Treatment of Manifestations Table 4. Treatment of Manifestations in Individuals with CM-AVM Syndrome
The clinician should have a low threshold to repeat imaging studies if clinical signs/symptoms of AVMs/AVFs become evident over time.
Source: GeneReviews — "Capillary Malformation-Arteriovenous Malformation Syndrome"
Phenotype severity distribution: 1 always present feature.
No clinical trials have been registered for capillary malformation-arteriovenous malformation 2.
13 publications have been identified in PubMed for capillary malformation-arteriovenous malformation 2. Research spans Case Report / Case Series (77%), Review / Meta-Analysis (8%), and Clinical Trial Publication (8%).
Research Type | Count | % of Total |
|---|---|---|
Patient case studies | 10 | 77% |
Data assembled from 6 of 12 sources · Last updated Sep 19, 2026, 8:01 AM UTC
Online Mendelian Inheritance in Man
Genetic and Rare Diseases Info Center
The clinical manifestations of RASA1-capillary malformation-arteriovenous malformation (RASA1-CM-AVM) syndrome have been described in many individuals with large cohorts by (n=39), (n=101), and (n=138), with insights from a number of other case series and case reports [, , , , , , , , , , , , ]. The clinical manifestations of EPHB4 capillary malformation-arteriovenous malformation (EPHB4-CM-AVM) syndrome have been described in two studies by (n=102), and (n=10). Significant intra- and interfamilial variability in the existence and location of vascular malformations has been described.
Table 2.
Features of Capillary Malformation-Arteriovenous Malformation
Feature | % of Persons w/Feature by Associated Gene
RASA1-CM-AVM1 | EPHB4-CM-AVM2
| ~97% | 100%
Arteriovenous
Source: GeneReviews — "Capillary Malformation-Arteriovenous Malformation Syndrome"
EPHB4. Penetrance of EPHB4-CM-AVM syndrome was reported to be 93% (102 of 110 individuals) in one study by . RASA1. Penetrance is 90%-99% for RASA1-CM-AVM syndrome. determined that 55 of 57 individuals heterozygous for a germline RASA1 pathogenic variant were affected. determined that 136 of 138 individuals heterozygous for a germline RASA1 pathogenic variant had multiple CMs.
Source: GeneReviews — "Capillary Malformation-Arteriovenous Malformation Syndrome"
Table 3. Other Genes of Interest in the Differential Diagnosis of Capillary Malformation-Arteriovenous Malformation (CV-AVM) Syndrome
Gene(s) | Differential Disorder | MOI | Clinical Features of Differential Disorder |
|---|---|---|---|
Hereditary hemorrhagic telangiectasia | AD | Multiple AVMs that lack intervening capillaries result in direct connections between arteries veins | Spontaneous recurrent nosebleeds (epistaxis) are more common.; Telangiectases generally only on lips, nose, hands; ~25% may have GI bleeding later in life.; Large capillary malformations are not typical. |
GNAQ | Sturge-Weber syndrome (SWS) (OMIM 185300) | Seefootnote 2. | Intracranial vascular anomaly3 |
PIK3CA | Klippel-Trenaunay-Weber syndrome5 | Seefootnote 6. | CMs hypertrophy of the related bones soft tissues |
PTEN | PTEN hamartoma tumor syndromes8 | AD | Overgrowth fast-flow lesions |
Multiple cutaneous and mucosal venous malformations | AD | Cutaneous VMs can be mistaken for CMs. | Small, multifocal bluish cutaneous /or mucosal VMs, usually present at birth. New lesions appear w/time.; Small lesions are usually asymptomatic; larger lesions can invade subcutaneous muscle cause pain. |
GLMN | Hereditary glomuvenous malformations (GVMs) (OMIM 138000) | AD | Cutaneous VMs can be mistaken for CMs. |
Source: GeneReviews — "Capillary Malformation-Arteriovenous Malformation Syndrome"
Genetic testing for EPHB4 is available. Testing is considered confirmatory for diagnosis.
Manifestation/Concern | Treatment | Considerations/Other |
|---|---|---|
CMs telangiectases | Referral to dermatologist | To evaluate CMs of cosmetic concern discuss risks benefits of intervention |
AVMs/AVFs | Multidisciplinary team incl specialists in interventional radiology, neurosurgery, surgery, cardiology, dermatology depending on location symptoms | To determine treatment (e.g., embolization vs surgery); Risks benefits of intervention for AVMs AVFs must be considered. |
Cardiac overload | Referral to cardiologist | — |
Hemihyperplasia /or leg length discrepancy | Referral to orthopedist | Consider:; Lymphangiography to evaluate for lymphatic malformations;; Compression stockings for those w/evidence of lymphedema. |
Epistaxis (nosebleeds) | Humidification nasal lubricants; referral to otolaryngologist | If epistaxis, perform complete blood count for eval of anemia. The clinician should have a low threshold to repeat imaging studies if clinical signs/symptoms of AVMs/AVFs become evident over time. |
Source: GeneReviews — "Capillary Malformation-Arteriovenous Malformation Syndrome"
View trials for capillary malformation-arteriovenous malformation 2
Research summaries
1 |
8% |
Clinical study results | 1 | 8% |
Disease patterns and progression | 1 | 8% |
Wu L (2026). [PMID: 42215316](https://pubmed.ncbi.nlm.nih.gov/42215316/). *Am J Med Genet A*. [Case Report / Case Series]
Kenaston MW (2026). [PMID: 41052613](https://pubmed.ncbi.nlm.nih.gov/41052613/). *J Pain Symptom Manage*. [Case Report / Case Series]
Demir M (2026). [PMID: 41592542](https://pubmed.ncbi.nlm.nih.gov/41592542/). *Allergy Asthma Immunol Res*. [Epidemiology / Natural History]
Borthakur K (2026). [PMID: 41763666](https://pubmed.ncbi.nlm.nih.gov/41763666/). *BMJ Case Rep*. [Case Report / Case Series]
Lin Y (2026). [PMID: 41970387](https://pubmed.ncbi.nlm.nih.gov/41970387/). *Front Med (Lausanne)*. [Case Report / Case Series]
Jiao B (2025). [PMID: 41209280](https://pubmed.ncbi.nlm.nih.gov/41209280/). *Quant Imaging Med Surg*. [Clinical Trial Publication]
Goeser LE (2025). [PMID: 39431828](https://pubmed.ncbi.nlm.nih.gov/39431828/). *Am J Med Genet A*. [Case Report / Case Series]
Zeng Q (2025). [PMID: 39578666](https://pubmed.ncbi.nlm.nih.gov/39578666/). *J Dermatol*. [Case Report / Case Series]
Sanri A (2025). [PMID: 41409310](https://pubmed.ncbi.nlm.nih.gov/41409310/). *Mol Syndromol*. [Case Report / Case Series]
Echols TC (2025). [PMID: 40047120](https://pubmed.ncbi.nlm.nih.gov/40047120/). *Am J Med Genet A*. [Case Report / Case Series]