[Cholesterol embolism syndrome: a rare, but severe complication in patients with atherosclerosis]

Cholesterol embolization is a serious complication of atherosclerosis. Mainly, vascular manipulations during endovascular procedures or vascular surgery can release cholesterol crystals from atheromatous plaques. About 20 % are spontaneous emboli without precipitating event. The cholesterol crystals are distributed by the blood stream, occlude small arteries and induce inflammation. Typically, 2 to 6 weeks after a vascular procedure renal failure and characteristic cutaneous signs develop. Livedo reticularis and blue toes, although classic symptoms, are not pathognomonic and may be even absent. Vasculitis is an important differential diagnosis. Diagnosis can only be proven by skin, muscle or kidney biopsy. Alternatively, fundoscopy can show retinal cholesterol emboli. Therapy is mostly limited to symptomatic measures. Corticosteroids have no proven efficacy and may be harmful. Statins should be given to all patients due to their plaque stabilizing and anti-inflammatory properties. Randomized clinical trials are lacking in this field. Prognosis is limited. About 30-55 % patients with renal involvement need renal replacement therapy. Mortality is high with 15-30 % of patients dying during the first year.