A 70-year-old man underwent graft replacement for infrarenal abdominal aortic aneurysm, 50 mm in diameter. Postoperatively, he suffered from bilateral lower extremital ischemia. Although he underwent emergency embolectomy of both legs under general anesthesia, severe purplish discoloration of the distal lower extremities developed, and acute renal dysfunction occurred. He was diagnosed with cholesterol crystal embolization syndrome (CCE). We initiated intravenous steroid therapy and infused prostagrandin intraarterially and conducted low density lipoprotein (LDL) apheresis. However, his renal function did not improve and his bilateral toes became necrotic completely. Multiple organ failure rapidly worsened and he died at 38 days after surgery. CCE complicated with severe renal dysfunction is a lethal iatrogenic complication after surgery for abdominal aortic aneurysm. Because the number of CCE is likely to increase in the near future, we should study about CCE more seriously.