Cholesterol emboli resulting from severe atherosclerotic disease (embolizing from the abdominal aorta) may cause unilateral or bilateral livedo of the lower extremities, blue toes, purpura (bruising), ulcerations and gangrene. In the first photograph you will note small end vessel ulcerations and focal purpura. The second photograph demonstrates the classic “cholesterol cleft” observed within the center of small arterioles. If the atheromatous plaques are located above the renal artery, chronic kidney disease may occur.
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