Cholesterol crystal embolization: a possible complication of peripheral endovascular interventions

Cholesterol crystal embolization (CCE) is a possible complication of peripheral endovascular interventions. The diagnosis of CCE is suggested by the gradual onset of peripheral cutaneous manifestations (e.g., livedo reticularis, blue toe syndrome) accompanied by progressive increases in blood urea nitrogen and creatinine levels following an invasive arterial procedure. On occasion, it may present with non-specific clinical signs and symptoms, which contributes to underdiagnosis. CCE is associated with significant morbidity and mortality. Prompt recognition of the presenting signs and symptoms, as well as a combination of treatment modalities is essential to reduce the risk of morbidity and mortality. CCE should always be part of the differential diagnosis in patients with progressively deteriorating renal function following a peripheral endovascular intervention. After the presentation of CCE, avoidance of anticoagulation and further invasive vascular procedures (e.g., angiography), along with symptomatic and supportive therapeutic measures, may help to achieve a better outcome.