Buerger's disease

Thromboangiitis Obliterans

What is Buerger's Disease?

Also known as thromboangiitis obliterans, Buerger disease is a rare type of peripheral arterial disease that involves inflammation of the smaller and midsize arteries in the extremities. It is a progressive condition associated almost exclusively with tobacco use (smoking or smokeless tobacco), especially among young men. As it worsens, people tend to feel increasing pain in their legs (claudication), particularly after exertion.

Unless people are very careful to keep their hands and feet warm in the cold and to exercise the affected area of their body, severe cases can lead to tissue death (necrosis) and amputation. The disease is extremely rare among nonsmokers. The only known treatment is to quit smoking, after which patients can expect dramatic improvement if irreparable harm has not already occurred.

Buerger's Disease signs and symptoms

  • Intermittent pain in the instep or the leg when exercising. The pain improves with rest.
  • Pain, blueness, heat and tingling in the legs when exposed to cold.
  • Painful ulcers on the toes and fingertips (sometimes).


  • Unknown, but the disease is probably triggered by nicotine.
  • Cigarette smoking causes blood-vessel spasms, leading to obstruction of the essential blood vessels in the extremities.

Risk increases with

  • Collagen disease or atherosclerosis.
  • Stress.
  • Cold weather.
  • Family history of Buerger's disease.

Preventive measures

  • Don't smoke.
  • Avoid exposure to the cold. This also causes blood vessels to constrict and deprives extremities of a normal blood supply.

Expected outcomes

  • This condition is currently considered incurable. Symptoms can be controlled for a while, but the disease causes increasing disability especially if amputation is necessary.
  • Life expectancy is reduced.
  • Scientific research into causes and treatment continues, so there is hope for increasingly effective treatment and cure.

Possible complications

  • Fingertip ulcerations.
  • Muscle atrophy.
  • Gangrene in the foot or leg caused by a loss of blood supply. This may result in amputation.

Buerger's Disease treatment

  • Diagnostic tests may include ultrasound, plethysmography to help detect decreased circulation in the peripheral vessels and arteriography to locate lesions.
  • The primary goals of treatment are to relieve symptoms and prevent complications.
  • Other measures are rarely successful if smoking continues, so stop smoking. Get help with a smoking cessation program if needed.
  • Avoid exposure to the cold. Wear warm footwear and gloves.
  • Clip nails carefully to avoid injuring the skin.
  • Wear well-fitting shoes and cotton or wool socks. Don't wear socks made of synthetic material.
  • Insert soft padding in your shoes to protect your feet.
  • Don't go barefoot outdoors.
  • Surgery (sympathectomy) to cut sympathetic nerves to the area (sometimes).
  • If gangrene develops, amputation of the affected limb, toes or fingers is likely.
  • Counseling may be recommended to help with lifestyle changes required to cope with the restrictions of the disease.

Additional Information


Vasodilators (drugs that widen the blood vessels) may be prescribed, but they are of little value if you continue smoking.


Avoid cold weather, but stay active. Begin a conditioning program to become as physically fit as possible.


No special diet. Maintain good nutrition.

Notify your physician if

  • You or a family member has symptoms of Buerger's disease.
  • Uncontrollable pain begins.
  • Ulcers develop on your fingers or toes.