[Cholesterol embolism syndrome after coronary angiography]

Cholesterol crystal embolization (cholesterol embolism, cholesterol embolic disease) is a multiorgan disease, which is a severe iatrogenic complication from an invasive vascular procedure, such as manipulation of the aorta during angiography or vascular surgery, and after anticoagulant and fibrinolytic therapy. The diagnosis is made postmortem in two-thirds of cases. Cholesterol crystal embolism is an increasing and still underdiagnosed disease. Pathognomonic is the constellation of acral pain, nonhealing ulcerations and necrosis, livedo racemosa with intact peripheral arterial pulses and sudden onset of renal failure and arterial hypertension. Biopsy of the affected organs is essential for diagnosis. We report the case of a 66-year-old man who following coronary arteriography with PTCA and implantation of stents developed acral necrosis and cyanosis, livedo racemosa and acute irreversible renal failure.