An Overview of Buerger’s Disease

Blood vessels in your limbs become inflamed, leading to infection

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Buerger’s disease (also known as thromboangiitis obliterans) is a type of vasculitis that causes inflammation, swelling, and blood clotting in the arteries and veins surrounding the hands and feet.

This narrowing restricts blood supply, which eventually leads to damaged skin tissue, infection, and in severe cases gangrene or complete tissue death. In cases of extreme gangrene, this may lead to amputation of the body part affected.

Most cases of Buerger's disease occur in young men ages 20 to 40 who are heavy smokers. It is most prevalent in countries whose residents use tobacco heavily, such as in the Middle East, Southeast Asia, and India.

This article covers the causes and symptoms of Buerger's disease. It also discusses how the disease is diagnosed and the treatment options that are available.

Buerger's disease symptoms

Verywell / Brianna Gilmartin


Common symptoms of Buerger’s disease include:

  • Pale, red, or blue-tinted hands and feet
  • Cold hands or feet
  • Severe pain in hands and feet that may feel like burning or tingling
  • Pain in the lower arms and legs while at rest due to limited blood supply
  • Pain when walking in the legs, ankles, or feet (most commonly in the arch of the foot)
  • Sores or ulcers on the hands and feet that are often painful
  • Lack of blood flow to fingers and toes in cold weather (known as Raynaud’s phenomenon)

Very rarely, if abdominal (mesenteric) arteries and veins are affected, a person with Buerger's may also feel extreme heaviness and pain in their abdomen. Some people also experience extreme weight loss.

Buerger’s disease tends to occur in short episodes. Symptoms typically last between one and four weeks before temporarily subsiding.

Although the disease is most often seen in males between the ages of 20 and 40, it is becoming more common in women. This is most likely due to the rise of cigarette smoking in women.

Because Buerger’s disease causes lack of blood flow, symptoms are mainly confined to extremities like the fingers and toes, leaving internal organs unaffected.


Almost all patients diagnosed with Buerger’s disease smoke cigarettes or use other forms of tobacco.

While researchers are unclear on the exact link between tobacco and Buerger’s disease, it’s thought that the chemicals in tobacco irritate the lining of the blood vessels, causing inflammation and swelling.

For this reason, those who smoke hand-rolled, raw tobacco without a filter are at the greatest risk, as the tobacco is most potent this way.

Smokers who smoke at least a pack and a half a day are at the greatest risk of being diagnosed with the disease.

Other, less prevalent causes of Buerger’s disease include genetic predispositions and, in rare cases, an autoimmune disease in which the body attacks healthy tissue for unknown reasons. Long-term chronic gum disease can also lead to Buerger’s disease.


In order to be properly diagnosed with Buerger’s disease, a number of other diseases that cause limited blood flow are often ruled out first.

Your healthcare provider will do a thorough examination to determine that these other disorders are not the cause of inflammation and swelling in the arteries and veins. Treatment plans for disorders that are not Buerger’s disease are very different in nature.

In addition to undergoing an exam, you should give your healthcare providers an up-to-date history of your tobacco use.

With this information, healthcare providers will perform a blood test and possibly an angiography—an imaging technique in which dye is injected to view the blood vessels in the arms and legs via X-ray.

Your healthcare provider may also conduct an Allen test to check the blood flow in the arteries linked to your hand.

With this test, you’ll make a tight fist to force the blood out of your hand. Your healthcare provider will then press on the arteries on each side of your wrist to slowly flow blood back into your hand, noting the color of your hand during this process. You’ll then open your hand as your practitioner releases the pressure on each artery (doing one at a time).

The Allen test will show how quickly the circulation in your hand returns your skin to its normal color. This will give insight into the health of your arteries, as slow blood flow is a sign of Buerger’s disease.

Buerger’s disease may be confused with another form of vasculitis or related disease, such as scleroderma or atherosclerosis.

Scleroderma is a rheumatic disease characterized by inflammation and pain in the muscles, joints, and connective tissue. Atherosclerosis is a progressive disease in which cholesterol plaque builds up in the walls of arteries, restricting blood flow.

Both of these conditions have symptoms similar to Buerger’s disease. This makes it important for your healthcare provider to have your entire health history when trying to pinpoint the correct cause of blood flow issues.


The symptoms of Buerger’s disease will only stop progressing when a patient stops smoking or using other forms of tobacco products.

In some cases, quitting tobacco may result in a complete remission of the disease and its side effects.

Medication will not cure Buerger’s disease, but can often help control the symptoms of the disease. It should be noted that anti-inflammatories and blood thinners have varied degrees of success, depending on the patient.

More extensive measures such as surgery may be needed to help improve blood flow to certain areas. This includes possible amputation if certain areas of the body have extreme and irreversible tissue death.

Most patients who stop smoking will not have to resort to more invasive procedures like surgery. In rare cases where patients with Buerger’s disease are not smokers, medication may be used to help dilate blood vessels, reduce blood clots, improve blood flow, or even stimulate the growth of new blood vessels (a more recent experimental approach to the disease).

Regular and frequent compression to the arms, legs, and other affected extremities to improve blood flow may also be part of the treatment plan.


Buerger's disease is a rare form of vasculitis that mostly occurs in heavy smokers. The disease causes inflammation and blood clots in blood vessels, which cut off blood flow to the extremities. Smoking cessation is the only way to stop the disease from progressing to gangrene. Those who do not stop may eventually need to have the body part(s) affected by gangrene amputated.

A Word From Verywell

Getting diagnosed with Buerger’s disease can be scary, but patients should take comfort in the fact that quitting smoking and other tobacco products has enormous success rates in halting the disease. Among the other health reasons to stop smoking immediately, avoiding the symptoms and side effects of Buerger’s disease should be top of mind for those thinking about smoking cessation and living a healthier lifestyle. 

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Smoking and Buerger's disease.

  2. UC Davis Health. Buerger's disease (thromboangitis obliterans).

  3. Vijayakumar A, Tiwari R, Kumar Prabhuswamy V. Thromboangiitis obliterans (Buerger's disease)—current practices. Int J Inflam. 2013 Sep;2013(1):1-9. doi:10.1155/2013/156905

  4. Johns Hopkins Vasculitis Center. Buerger's disease.

  5. Seebald J, Gritters L. Thromboangiitis obliterans (Buerger disease). Radiol case rep. 2015 Oct;10(3):9-11. doi:10.1016/j.radcr.2015.06.003

By Colleen Travers
Colleen Travers writes about health, fitness, travel, parenting, and women’s lifestyle for various publications and brands.