The clinical consequences of cholesterol embolisation vary considerably. Patients may be completely asymptomatic when the diagnosis is made coincidentally at renal biopsy or they may present with a distinct clinical syndrome that is associated with a high mortality. As only a minority of patients sustaining cholesterol emboli are recognised clinically, the actual incidence and pathophysiology of the syndrome remains uncertain.

Typical features of the clinical syndrome include livedo reticularis and painful focal digital ischaemia, characteristically with a normal peripheral arterial pulse (the purple toe syndrome). Other clinical features include retinal embolisation, renal failure (usually with baseline renal impairment), labile blood pressure, and abdominal symptoms that may vary depending on which organ is involved.1

Tissue biopsy is the diagnostic investigation …