The cholesterol emboli syndrome is a disorder caused by showers of microemboli which impact the small arteries. It can occur spontaneously or be precipitated by vascular surgery, arteriography or anticoagulation. The typical patient is a man older than 60 years with risk factors for atherosclerotic disease. The organs most often affected are the kidneys, skin, muscles and abdominal viscera. Common clinical presentations include renal failure and livedo reticularis or gangrene of the toes with intact pulses. Eosinophilia and hypocomplementemia may occur. The syndrome can be fatal or result in end-stage renal disease, but partial recovery can also occur.