Background and Objectives: Blue toe syndrome is an uncommon form of cutaneous manifestation of cholesterol crystal embolization which caused by angiography, vascular surgery or anticoagulation. Methods: We retrospectively reviewed the medical records of patients who were diagnosed with blue toe syndrome in Samsung medical center from 1994 to 2008. Results: In 26 patients (mean age 72 years; 84% males; hypertension in 84% patients; DM 53% ; history of CAD 76%; PAOD 57%) with blue toe syndrome, 20 patients (77%) was precipitated by vascular manipulation during angiography or surgery and 6 (23%) were spontaneous. The median duration of symptom onset was 23 days (Range 0 – 69). The prevalence of eosinophilia (>500 /ul) was 61% (in 16 patients) and the blood eosinophil count was 624.0짹418.2 /ul. Patients with blue toe syndrome had following associated conditions: ARF in 13 patients (50%), livedo reticularis 5 (19%), digital gangrene 1 (4%) and Hollenhorst plaques 3 (11%). Severe thoracic aortic plaque was found in 9 patients (35%) on TTE and complex plaque (>4mm, ulceration) in 14 patients (53%) on CT. Biopsy was performed in 9 patients (34%) and revealed cholesterol embolism in 5 cases (55%). Treatment included acute HD in 3 patients (11.5%), 3 patients (11.5%) underwent operation and 20 patients were received conservative management. During the clinical follow-up (median of 5.0 months), 2 patients (7%) died, 8 patients (30%) required dialysis and 4 patients (15%) experienced limb loss. There was higher tendency of limb loss rate in patients with painful ulceration on the affected toe. The incidence of clinical events including limb loss, new dialysis and death increased in patient with decreased glomerular filtration rate (GFR) (p=0.015). Conclusion: Blue toe syndrome is a relatively rare but serious complication after vascular intervention. Decreased baseline GFR is associated with subsequent clinical events