Buerger’s disease restricts blood flow in the small and medium arteries. The exact cause is unclear, but tobacco use has strong links to the condition.

The condition mostly affects the limbs. A person’s symptoms vary depending on the location of the inflammation and the extent of the blood flow restriction.

This article examines Buerger’s disease, how doctors identify it by the signs and symptoms, and the risk factors that increase the likelihood of developing the condition.

We also look at the possible causes, potential complications, diagnosis, treatment, and the general outlook for people with Buerger’s disease.

Symptoms of Buerger's diseaseShare on Pinterest
Medical Illustration by Bailey Mariner

In 1908, Leo Buerger first identified Thromboangiitis obliterans, now commonly called Buerger’s disease.

It is a fairly rare condition that affects around 12.6–20 out of every 100,000 people in the United States.

Buerger’s disease results in swelling in the small and medium arteries, mostly in the limbs. It often affects the legs more than the arms. The swelling causes blockages in the vessels restricting blood flow and can lead to clots forming.

This disease causes pain in the areas it affects and can result in damage and death to the nearby body tissues.

Most signs and symptoms of Buerger’s disease result from the lack of oxygen to body tissues — when the blood vessels become inflamed, they block the blood from flowing freely.

The type and severity of symptoms depend on the location of the inflammation and the extent of the blood flow restriction.

The most common signs and symptoms of Buerger’s disease are:

  • blue, red, or pale tinge to fingers or toes
  • small, painful sores developing on the fingers or toes
  • skin changes on the fingers or toes
  • cold hands or feet
  • burning or tingling pain in the hands or feet
  • when walking, pain in the:
    • legs
    • ankles
    • feet, or foot arches

In severe cases, the condition can completely cut off the blood flowing to a limb leading to gangrene and infection, as it causes the tissues to die.

The main risk factor for Buerger’s disease is tobacco use. According to the Centers for Disease Control and Prevention (CDC), almost every person who experiences Buerger’s disease uses some form of tobacco product.

This is because tobacco contains chemicals that irritate the lining of the blood vessels, causing inflammation. The inflammation directly restricts blood flow by narrowing the vessels and can cause clots to form.

Other risk factors include age and sex. Buerger’s disease typically affects people 20–50 years old and does not occur in children or older people. Additionally, it affects three times as many males as females, though this may relate to a higher prevalence of males who smoke or chew tobacco.

According to research from 2016, the prevalence of Buerger’s disease also varies with global distribution. The condition is more prevalent in the Middle East and the Far East than in Western Europe or North America.

Other conditions can cause inadequate oxygenated blood supply to the tissues in the arms and legs.

These conditions can include:

  • Atherosclerosis: Hardening of the arteries due to a buildup of plaque.
  • Diabetes: This can cause fatty deposits to collect in the blood vessels.
  • Thrombophilic states: Blood clots in the vessels.
  • Autoimmune diseases: When the immune system overreacts, it causes the body to attack healthy cells.

In some rare cases, Buerger’s disease can cause blockages in blood vessels outside the limbs, including those passing oxygen to the:

Some conditions present the same symptoms as Buerger’s disease, despite being separate disorders. These include scleroderma and Takayasu arteritis.


Scleroderma is an autoimmune disorder that damages the blood vessels and causes the skin to thicken and become hard. It can be localized, affecting the muscles and bones, or systemic, affecting the internal organs, such as the heart.

The effects of scleroderma on the skin can cause contraction in the blood vessels in the extremities. This condition can cause Raynaud’s phenomenon, limiting blood supply to the fingers and toes.

Takayasu arteritis

Takayasu arteritis is another similar condition, as it causes inflammation in the arterial blood vessels.

However, where Buerger’s disease affects the small and medium arteries, Takayasu arteritis typically damages the medium and large arteries and their branches, reducing blood flow around the body.

An important part of diagnosis is ruling out other possible causes of symptoms, so it is beneficial to consider related conditions.

When making a diagnosis, a doctor will consider the signs and symptoms of the condition and the history of tobacco use. They may then use a type of X-ray called an angiography to look at the blood vessels.

The results from a histology test provide the most accurate diagnosis, as a doctor can check the tissues for evidence of Buerger’s disease.

There is no direct cure for Buerger’s disease, but evidence shows that the outcome is generally positive when people with the condition stop smoking.

Other treatment strategies focus on managing symptoms, including:

  • Hyperbaric oxygen therapy improves symptoms in similar conditions such as diabetes. Research from 2018 showed that combining this therapy with conventional treatment for people demonstrated some benefits to symptoms.

Another method is surgical revascularization to help restore blood flow. Where possible, doctors try to avoid amputation as an option.

The outlook is generally positive for people who stop smoking or chewing tobacco after symptoms appear.

A person should speak with a doctor to receive a diagnosis and treatment. Left untreated, it could result in complications.

While very rare, occasionally, death can result from Buerger’s disease. For example, the condition caused 117 deaths in the U.S. between 1999 and 2007.

People should speak with a doctor to discuss ways to quit smoking and prevent Buerger’s disease symptoms from progressing.

Buerger’s disease is a condition that is likely to result from chewing or smoking tobacco. Chemicals from tobacco cause inflammation in the lining of the small and medium arteries, causing them to restrict blood flow. This can also cause clots to develop, resulting in tissue death or damage in the limbs.

The restriction to oxygenated blood flowing can cause symptoms in the arms and legs, starting with coldness, pain, tingling sensations, and color change. In severe cases, the condition can lead to gangrene and infection.

There is no direct cure for Buerger’s disease. The main treatment is for a person to eliminate all forms of tobacco and nicotine from the system. In severe cases, doctors may consider surgical procedures.