Buerger's Disease: Symptoms, Causes, and Treatment

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

A healthcare professional examines a patient's hand while assessing the signs of Buerger disease.

Quick answer

Buerger's disease (thromboangiitis obliterans) is a rare disease in which blood clots block the small blood vessels of the hands and feet. It causes numbness, skin color changes, painful sores and pain even at rest; blackened, foul-smelling skin can signal gangrene. There is no cure, and the only proven treatment is quitting all tobacco, including vaping and marijuana. [1] [6] [2]

What the research says

According to PubMed:

• Endovascular treatment saved most limbs in pooled data. A systematic review and meta-analysis of 27 studies with 1,217 patients with thromboangiitis obliterans and critical limb ischemia found a pooled technical success rate of 89% and limb salvage of 94% at 6 months and 97% at 12 months. Restenosis was 15% early and 34% late, and the authors stress smoking cessation for better outcomes. (Shaghayegh et al., DOI).

• Outcomes in a 100-patient cohort were more guarded. After endovascular therapy in 100 patients (mean age 41.5 years, 64% current smokers), technical success was 92%, limb salvage 47%, and amputation-free survival at 12 months 51%. Longer survival was linked to younger age (40 or under), never smoking, ulcer healing, and vessel patency. (Rodoplu, DOI).

• Gangrene and infection predict major amputation. In 41 patients with Buerger disease and critical limb ischemia in Jordan, gangrene at presentation (OR 11.545, 95% CI 1.444 to 92.332) and limb infection at admission (OR 7.745, 95% CI 1.182 to 50.755) predicted major limb amputation. (Aljarrah et al., DOI).

Study details are from PubMed abstracts.

What is Buerger's disease?

Buerger disease is a rare disease of the arteries and veins in the arms and legs. In this condition, the small blood vessels of the feet and hands become blocked with blood clots. [1]

This blockage reduces blood flow to the affected areas. Over time, the lack of blood flow damages or destroys skin tissue. [1]

The damage can lead to infection and death of body tissue, called gangrene. Buerger disease usually is first seen in the feet. It may eventually affect the blood vessels of the hand. Blood clots may also form in the small veins of the arms and legs. [1]

Key fact	What to know
Medical name	Thromboangiitis obliterans [1]
What happens	Blood clots block the small blood vessels of the hands and feet [1]
Where it starts	Usually in the feet; may spread to the hands [1]
Main driver	Tobacco use in nearly every case [1] [2]
Only proven treatment	Quitting all forms of tobacco [1] [2]
Serious complication	Gangrene, which often requires surgery [1]

What are the symptoms of Buerger's disease?

Buerger disease progresses from healthy blood flow to blocked vessels and tissue damage.

Buerger disease symptoms affect the hands and feet. The signs come from poor blood flow through the small vessels of these areas. [1]

Sign	What to look for
Tingling or numbness	A pins-and-needles feeling or loss of feeling in the fingers or toes [1]
Skin color changes	The skin of the hands and feet may look pale gray, red, or blue [1]
Cold-triggered color change	Fingers and toes turn white then blue in the cold, known as Raynaud's phenomenon [1]
Walking pain	Pain in the feet that happens with walking and may limit distance [1]
Open sores	Painful sores on fingers and toes that may become severe and occur at rest [1]
Surface vein inflammation	Inflammation of a vein just below the skin's surface, caused by a blood clot [1]

Depending on your skin color, the color changes in your hands and feet may be harder or easier to see. The pain in the fingers and toes may grow severe enough to occur at rest, not just with activity. [1]

When should you seek emergency care for Buerger's disease?

See a health care provider if you think you have symptoms of Buerger disease. Early signs of poor blood flow deserve attention before sores form. Go in quickly if any of the following develop, since they can signal gangrene. [1]

Warning sign	Why it matters
Black or blue skin	Can mean body tissue is dying from lack of blood [1]
Loss of feeling in a finger or toe	Suggests damaged nerves and tissue [1]
Bad smell from the area	Signals infection and tissue death [1]
Sores that do not heal	Growing open sores can turn into gangrene [1]

Gangrene is a serious condition. Surgery is usually needed to remove the affected finger, toe, or other tissue. [1]

What causes Buerger's disease?

The exact cause of Buerger disease is unknown. The condition is strongly linked to tobacco use. [1] [2]

Experts think that chemicals in tobacco may hurt the lining of the blood vessels. This irritation is believed to start the clotting and blocking that cuts off blood flow. [1]

Researchers also think some people have genes that make them more likely to get Buerger disease. It is also possible the disease occurs when the body's immune system attacks healthy tissue by mistake. [1]

Who is at higher risk?

The biggest risk factor for Buerger disease is smoking or using any type of tobacco. The disease can occur in people who smoke cigarettes, use cigars, and chew tobacco. Rates of Buerger disease are highest in areas of the Mediterranean, the Middle East, and Asia, where heavy smoking is most common. [1] [2]

Risk factor	How it raises risk
Any tobacco use	The main driver; cigarettes, cigars, and chew tobacco all count [1] [2]
Being male	Men are diagnosed far more often [1]
Being under 45	Most cases occur in people younger than 45 [1]
Long-term marijuana use	May raise the risk of similar blood vessel problems [1]
Long-term gum infection	May increase risk, but more study is needed to confirm this link [1]

Some research says that long-term use of marijuana, also called cannabis, also raises the risk of blood vessel problems similar to those of Buerger disease. Long-term infection of the gums may also play a role, though more study is needed to confirm this link. [1]

How is Buerger's disease diagnosed?

No test can diagnose Buerger's disease directly, so a doctor cannot confirm it with one simple lab result or scan. Instead, tests are done to check for other common conditions that may cause similar symptoms. [6]

Diagnostic step	What happens
Blood tests	Check for diabetes, blood-clotting disorders, or autoimmune diseases such as scleroderma or lupus [6]
Artery exam of hands and feet	Blood pressure cuffs and ultrasound imaging show how blood moves through the hands and feet, often in a vascular laboratory [6]
CT or MRI scan of blood vessels	These tests show blood flow in the arteries; a special dye may be given by IV so the arteries show up more clearly [6]
Angiogram of hands and feet	A long, thin flexible tube called a catheter is inserted into a blood vessel; dye flows through the catheter so X-ray images and video show blockages in the very small blood vessels [6]

The artery exam can be done in a special vascular laboratory or at a medical provider's office. Other tests may also check blood flow to the skin. [6]

What are the treatment options for Buerger's disease?

The treatment options for Buerger disease center on quitting all tobacco, with medicines and other therapies for symptoms.

There is no cure for Buerger disease. The only proven treatment is to quit using all tobacco products. Even one cigarette a day can make the disease worse. [6] [2]

This rule includes electronic cigarettes, vaping, and marijuana. Nicotine replacement products are not an option because they still contain nicotine, and nicotine is thought to irritate the blood vessels. Your health care provider can recommend other medicines that might help with cravings. [6]

If quitting is hard, a live-in program may help. You typically stay at a treatment center or hospital for a few days or weeks. There you learn how to stop cravings for cigarettes and how to live tobacco-free. [6]

Other treatments can help with symptoms, but they do not work as well as quitting smoking. These options are covered below. [6]

Medicines

Your health care provider may recommend medicine to improve blood flow. For example, some blood pressure medicines may be helpful. Aspirin may be given to prevent blood clots. [6]

A medicine called bosentan (Tracleer) may be tried if symptoms are very severe. It is approved to treat high blood pressure in the lungs, but a few studies showed it improved blood flow in people with Buerger disease. [6]

Other medicines depend on your symptoms and other health conditions. Medicines may be given to treat pain or to help heal skin sores. [6]

Treatment	What it does
Blood pressure medicines	May improve blood flow to the affected areas [6]
Aspirin	Helps prevent blood clots [6]
Bosentan (Tracleer)	May improve blood flow in very severe cases [6]
Pain medicines	Ease pain from sores and poor circulation [6]
Sore-healing medicines	Help open skin sores heal [6]

Therapies

A medicine-free treatment called compression therapy may be suggested. Your provider may call it intermittent pneumatic compression pumping. [6]

During this therapy, you wear a sleeve over the affected arm or leg. The sleeve connects to a pump. The pump sends air into the sleeve on and off, so the sleeve inflates and gently squeezes the area. The pressure increases blood flow to the affected body area. [6]

Surgery

Buerger disease causes a severe lack of blood flow, which can damage skin tissue or cause it to die. Surgery may be needed to remove an arm or leg that is infected or has dead tissue. This surgery is called amputation. [6]

What lifestyle and home care helps with Buerger's disease?

Daily habits can improve symptoms and prevent complications. [6]

Home care step	Why it helps
Exercise regularly	With your provider's OK, aim for 30 to 60 minutes of activity most days to improve blood flow [6]
Check your skin daily	Loss of feeling means a cut may go unnoticed; inspect arms and legs every day and protect fingers and toes from cold and injury [6]
Clean cuts and scrapes	Poor blood flow raises infection risk; clean with soap and water, apply antibiotic ointment, and cover with clean bandages [6]
Care for teeth and gums	Visit a dentist regularly; long-term gum disease is linked to Buerger disease [6]
Avoid all tobacco smoke	No smoking, vaping, or marijuana, and stay away from secondhand smoke too [6] [2]

Even small cuts and scrapes can turn into serious infections when blood flow is low. If a skin injury gets worse or heals slowly, see a health care provider quickly. [6]

It is also important to stay away from smoke from all burning tobacco products and the smoke a tobacco user breathes out. This is called secondhand smoke. Any amount of secondhand smoke is bad for the heart and blood vessels. [6]

How can you prevent Buerger's disease?

Nearly everyone who has Buerger disease has smoked or used some form of tobacco. To prevent Buerger disease, the most important step is to not use tobacco. [1] [2]

Quitting smoking can be hard. Talk to a health care provider about ways to quit. [1]

How should you prepare for a Buerger's disease appointment?

You are likely to start by seeing your primary care provider. If you have symptoms of Buerger disease, you may be referred to a vascular specialist, a provider trained in blood vessel diseases. Take someone along to the visit if possible. A companion can help you remember the information you are given. [6]

What to bring	Details
Your symptoms	Include any that may not seem related, and note when they began
Personal information	Note any smoking or tobacco use, and any work with vibrating tools such as a jackhammer, which can cause blood vessel injuries to the hands or feet
All medicines	List all medicines, vitamins, and supplements you take, including doses
Questions	Prepare questions to ask your provider

Some basic questions to ask include: What is the most likely cause of my symptoms? What tests do I need? What treatment options exist, and which do you recommend? I have other health conditions; how can I best manage them together? Should I see a specialist? Are there brochures or recommended websites I can have?

Your health care provider might ask you several questions in return: Do your symptoms come and go or last all the time? How bad are they? Does anything seem to make them better or worse? Do your fingers change color in the cold?

Conclusion

Buerger disease is a rare but serious disease of the blood vessels in the arms and legs, and tobacco use sits at the center of nearly every case. It starts with tingling, color changes, and pain in the fingers and toes, and it can progress to open sores and gangrene. [1]

The key takeaway is simple: there is no cure, but quitting all tobacco is the only proven way to stop the disease from getting worse. Medicines, compression therapy, skin care, and exercise can ease symptoms, but they cannot replace quitting. [6] [2]

Next steps: If you use tobacco and notice your fingers or toes changing color, tingling, or aching with walking, talk to a health care provider soon. Even one cigarette a day can make Buerger disease worse. If you want support quitting, your provider can recommend medicines and programs that work.

Frequently asked questions

Does Buerger disease only affect smokers?

Nearly everyone who gets Buerger disease uses some form of tobacco, and quitting all tobacco is the only proven treatment. Even one cigarette a day can make the disease worse. [1] [6] [2]

What is the difference between Buerger disease and Raynaud's phenomenon?

Buerger disease blocks the small blood vessels of the arms and legs with clots, while Raynaud's phenomenon is fingers and toes turning white then blue when exposed to cold. Raynaud's color changes can be one of the signs of Buerger disease. [1]

Can Buerger disease be cured with medicines or surgery?

There is no cure. Medicines, compression therapy, and surgery can treat symptoms, but quitting all tobacco is the only treatment proven to stop the disease. [6] [2]

Why are nicotine patches not safe for Buerger disease?

Nicotine replacement products still contain nicotine, and nicotine is thought to irritate the blood vessels, so they are not an option. Your provider can recommend other quitting medicines instead. [6]

What happens if Buerger disease is left untreated?

Without quitting tobacco, the lack of blood flow can cause painful sores that do not heal and lead to gangrene, the death of body tissue. Surgery to remove the affected finger, toe, or other tissue is usually needed. [1]

This article is for general education and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional about your individual situation.

References

1. Mayo Clinic Staff. Buerger disease - Symptoms and causes. Mayo Clinic. December 19, 2024. https://www.mayoclinic.org/diseases-conditions/buergers-disease/symptoms-causes/syc-20350658

2. Centers for Disease Control and Prevention. Smoking and Buerger's disease. CDC. October 13, 2023. https://www.cdc.gov/tobacco/campaign/tips/diseases/buergers-disease.html

3. Shaghayegh A, Almusawi R, Yousefnezhad Y, et al. A systematic review and meta-analysis of early and long-term outcomes after endovascular interventions in patients with thromboangiitis obliterans and critical limb ischemia with GRADE assessment. BMC Surg. 2026;26(1). PMID 41699570. https://doi.org/10.1186/s12893-026-03563-2

4. Rodoplu O. Long-term outcomes of endovascular therapy in Buerger disease with critical limb ischemia: a retrospective observational study. Int Angiol. 2026;45(3):181-190. PMID 42017702. https://doi.org/10.23736/S0392-9590.26.05528-8

5. Aljarrah Q, Al-Badaineh M, Salman HB, et al. Clinical outcomes of critical limb ischemia in Buerger disease: a contemporary analysis from an academic referral center in Jordan. PLoS One. 2026;21(6):e0351071. PMID 42268806. https://doi.org/10.1371/journal.pone.0351071

6. Mayo Clinic Staff. Buerger disease - Diagnosis and treatment. Mayo Clinic. December 19, 2024. https://www.mayoclinic.org/diseases-conditions/buergers-disease/diagnosis-treatment/drc-20350664