Buerger’s disease is rare, but it is more commonly found in regions with high smoking rates, including parts of Asia, the Middle East, and Eastern Europe. It primarily affects young to middle-aged men (ages 20–45) who are heavy smokers, though cases in women are increasingly reported. The overall prevalence is estimated to be between 12.6 - 20 per 100,000 people, with much higher rates in populations with widespread tobacco use.

The exact cause of Buerger’s disease is unknown, but it is strongly linked to tobacco use, including cigarette smoking, chewing tobacco, and even secondhand smoke exposure. Some researchers believe that a hypersensitive immune response to tobacco toxins leads to inflammation in the blood vessels. Genetic factors and autoimmune mechanisms may also play a role in disease susceptibility.

Buerger’s disease primarily affects the limbs, causing symptoms such as:

• Pain in the hands and feet (claudication): Pain occurs when walking (intermittent claudication) or at rest in severe cases.

• Changes in skin color in fingers/toes and hands/feet from grey, red, and blue: These affects may be easier/harder to see depending on skin tone
   

• Cold sensitivity (Raynaud’s phenomenon): Affected fingers and toes may turn white or blue in response to cold temperatures.
   

• Numbness and tingling: Poor circulation leads to loss of sensation in the fingers and toes.
   

• Ulcers and non-healing wounds: Painful sores can develop on the fingers, toes, or feet due to poor blood flow.
   

• Gangrene: In advanced cases, tissue death occurs, requiring amputation.

• Migratory thrombophlebitis: Superficial vein inflammation and clotting may occur in different areas of the body

There is no single test to diagnose Buerger’s disease. Diagnosis is based on clinical criteria, patient history (especially smoking habits), and the exclusion of other conditions that cause vascular disease, such as atherosclerosis, autoimmune disorders, and diabetes.

• Angiography (CT or MR angiography): Identifies characteristic "corkscrew" narrowing and blockages in blood vessels, particularly in the hands and feet.

• Doppler Ultrasound: Assesses blood flow and detects vascular abnormalities.

• Blood Tests: Rule out other conditions like autoimmune diseases or clotting disorders.

• Allen’s Test: Evaluates blood flow to the hands by compressing the radial and ulnar arteries.
   

There is no cure for Buerger’s disease, and treatment focuses on managing symptoms and preventing progression. The most critical step is complete tobacco cessation, as continued smoking worsens the disease. Additional treatments include:

• Medications: Vasodilators (e.g., calcium channel blockers), blood thinners (aspirin, anticoagulants), and pain management drugs.

• Hyperbaric Oxygen Therapy: Used in severe cases to improve wound healing.

• Surgical Interventions: Sympathectomy (nerve surgery) may help with pain relief, but revascularization procedures (bypass surgery) are often ineffective due to widespread small-vessel involvement.

• Amputation: Required in advanced cases with irreversible tissue damage and gangrene.

The prognosis depends on early diagnosis and smoking cessation. If a person quits smoking entirely, the disease progression can be halted, and further complications can be prevented. However, continued tobacco use leads to worsening symptoms, gangrene, and a high likelihood of limb amputation. Lifelong management and lifestyle modifications are essential to maintaining quality of life.

1. Mayo Clinic - Buerger disease

2. Cleveland Clinic - Buerger’s disease

3. Smoking and Buerger’s disease - CDC