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Following a Coronary artery bypass graft and insertion of an intra-aortic balloon pump, the 63 year-old male patient developed signs of progressive multi-organ dysfunction and ischaemic changes in both of his lower limbs. The diagnosis of cholesterol embolization syndrome was made. This condition has been noted to be a complication of invasive procedures and endovascular therapies, and is often overlooked and difficult to treat. While the patient’s renal function and pancreatitis showed improvement, the lower limb ischaemia was progressing. Eventually, the patient underwent a bilateral below knee amputation.