JACC. Case reports · 2026
A Rare Large-Artery Complication of Cryoglobulinemia: Superior Gluteal Artery Pseudoaneurysm.
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Dawoud Abdallatif, Safi Mohammad, Taylor Maddy, Rooks Angela, Eid Daniel, Shin Alexa, Mahdi Ahmad, Altorok Nezam
Аннотация
BACKGROUND: Cryoglobulinemia is an immune complex-mediated vasculitis that predominantly affects small and medium-sized vessels. Involvement of large arteries is exceedingly rare, and pseudoaneurysm formation has rarely been described.
CASE SUMMARY: A 44-year-old man with hepatitis C-negative cryoglobulinemic vasculitis and a mechanical aortic valve on chronic anticoagulation presented with acute left gluteal pain, near syncope, and severe anemia. Computed tomography angiography revealed a large left gluteal hematoma with active arterial extravasation. Digital subtraction angiography demonstrated a markedly enlarged superior gluteal artery supplying a large pseudoaneurysm. Distal-to-proximal endovascular embolization resulted in complete exclusion of the pseudoaneurysm and hemodynamic stabilization.
DISCUSSION: This case illustrates an exceptionally rare large-artery complication of cryoglobulinemia, highlighting the potential for immune-mediated vascular injury to extend beyond the small- and medium-vessel circulation. The deep anatomic location of the superior gluteal artery can obscure early diagnosis, and delayed recognition may result in life-threatening hemorrhage.
CONCLUSIONS: Clinicians should consider vasculitic etiologies, including cryoglobulinemia, in patients presenting with spontaneous pseudoaneurysm formation and acute hemorrhage in the absence of trauma. Early recognition and endovascular intervention can be lifesaving.
CASE SUMMARY: A 44-year-old man with hepatitis C-negative cryoglobulinemic vasculitis and a mechanical aortic valve on chronic anticoagulation presented with acute left gluteal pain, near syncope, and severe anemia. Computed tomography angiography revealed a large left gluteal hematoma with active arterial extravasation. Digital subtraction angiography demonstrated a markedly enlarged superior gluteal artery supplying a large pseudoaneurysm. Distal-to-proximal endovascular embolization resulted in complete exclusion of the pseudoaneurysm and hemodynamic stabilization.
DISCUSSION: This case illustrates an exceptionally rare large-artery complication of cryoglobulinemia, highlighting the potential for immune-mediated vascular injury to extend beyond the small- and medium-vessel circulation. The deep anatomic location of the superior gluteal artery can obscure early diagnosis, and delayed recognition may result in life-threatening hemorrhage.
CONCLUSIONS: Clinicians should consider vasculitic etiologies, including cryoglobulinemia, in patients presenting with spontaneous pseudoaneurysm formation and acute hemorrhage in the absence of trauma. Early recognition and endovascular intervention can be lifesaving.