The case was a 72-year-old man with angina pectoris, diabetes mellitus, hypertension. He was active smoker. He had been hemodialyzed using heparin sodium as anticoagulant for end stage renal failure 5 months before. He underwent percutaneous coronary intervention（PCI）due to angina pectoris. He complained of painful digital cya-nosis on the right foot about 6 weeks after the vascular procedure. Bilateral dorsalis pedis pulses were palpable. Laboratory data indicated eosinophilia and elevation of C-reactive protein. We performed a skin biopsy of the right sole and diagnosed him with cholesterol crystal embolism （CCE）. Catheter manipulation and anticoagulant ther-apy were considered to be causes of CCE. The anticoagulant used in hemodialysis was changed from heparin sodium to nafamostat mesilate. Black blood Magnetic Resonance Image （BB-MRI） revealed multiple unstable plaques of the abdominal aorta. We reported diabetic hemodialysis patient with CCE after catheter manipulation. BB-MRI is useful to assess atherosclerotic plaques of the aorta in patients with a high risk of CCE.

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