Improvement in cholesterol emboli syndrome after iloprost therapy.

Cholesterol emboli syndrome is a disorder in which multiple cholesterol crystals dislodge from atherosclerotic plaques, either spontaneously or after vascular interventions, treatment with anticoagulation, or thrombolytic treatment. The syndrome typically presents with painful ischaemic skin lesions, livedo reticularis, and acute renal failure. Treatments such as aspirin, statins, discontinuation of anticoagulation, and surgical correction of the embolic source are of limited efficacy. 2 We report four cases of cholesterol emboli in which treatment with iloprost, a prostacyclin analogue, improved both ischaemia of the distal extremities and renal failure.