Objective: To emphasize the importance of peripheral cholesterol microembolization following interventional radiologic procedures. Case report: A 50-year-old man with ischemic symptoms of lower extremity was admitted to our hospital. On angiography, he had long segment right iliac artery occlusion, short segment stenosis of the left common iliac artery and diffuse aortic atheromatous plaque. Iliac artery occlusion was recanalized and stented successfully. Left main iliac stenosis was dilated by percutaneous transluminal angioplasty (PTA). Five days later, oedema, livedo reticularis and discoloration developed in bilateral lower extremity. Gastrocnemius muscle biopsy revealed cholesterol microemboli in small arteries. The disease was treated by anticoagulation and thrombolytic therapy but the patient developed multiorgan failure and died of cardiopulmonary insufficiency within 3 days. Conclusions: Blue toe syndrome following interventional radiological procedures is life-threatening and can cause severe morbidity and even mortality. Interventional radiologist should be aware of this complication and embolic sources.