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Key Features

Essentials of Diagnosis

  • Typically occurs in male cigarette smokers

  • Distal extremities involved with severe ischemia progressing to tissue loss

  • Thrombosis of the superficial veins may occur

  • Smoking cessation is essential to stop disease progression

General Considerations

  • Buerger disease is a segmental, inflammatory, and thrombotic process of the distal most arteries and occasionally veins of the extremities

  • Cause is unknown but condition is rarely seen in nonsmokers

  • Pathologic examination reveals arteritis in affected vessels

  • Arteries most commonly affected are the plantar and digital vessels of the foot and lower leg

  • In advanced stages, the fingers and hands may become involved

  • Progression of disease seems to be intermittent with acute and dramatic episodes followed by some periods of remission


  • Patients usually younger than 40 years old

  • Incidence has decreased dramatically

Clinical Findings

Symptoms and Signs

  • Lesions on the toes

  • Superficial thrombophlebitis may aid the diagnosis

  • Rest pain, particularly in the toes

  • Pain often progresses to tissue loss and amputation, unless patient stops smoking

  • Intermittent claudication is not common

Differential Diagnosis

  • Peripheral vascular disease

  • Raynaud disease

  • Repetitive atheroemboli


Imaging Studies

  • Magnetic resonance angiography or invasive angiography can demonstrate the obliteration of the distal arterial tree

  • Biopsy of a tender cord from migratory thrombophlebitis is no longer necessary



  • Sympathectomy is rarely effective

Therapeutic Procedures

  • Smoking cessation is mainstay of therapy and will halt disease in most cases

  • Revascularization is often not possible because the distal arterial tree is occluded



  • Amputation


  • Prognosis dependent on smoking cessation

    • For patients who stop smoking, outlook may be better

    • For those who do not stop smoking, prognosis is poor


Jorge  VC  et al. Buerger's disease (Thromboangiitis obliterans): a diagnostic challenge. BMJ Case Rep. 2011 Sep 13;2011. pii: bcr0820114621.
[PubMed: 22679237]
Klein-Weigel  P  et al. Buerger's disease: providing integrated care. J Multidiscip Healthc. 2016 Oct 12;9:511–8.
[PubMed: 27785045]
Le Joncour  A  et al; French Buerger's Network. Long-term outcome and prognostic factors of complications in thromboangiitis obliterans (Buerger's disease): a multicenter study of 224 patients. J Am Heart Assoc. 2018 Dec 4;7(23):e010677.
[PubMed: 30571594]

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