---
title: Thromboangiitis obliterans
description: What thromboangiitis obliterans (Buerger disease) is, why it is linked to smoking, how it is recognised, why the main treatment is giving up tobacco completely and when to call an ambulance.
type: disease
aliases:
  - Buerger disease
  - Buerger's disease
sources:
  - tier: guideline
    org: minzdrav-rf
    title: Хроническая ишемия нижних конечностей с клиникой перемежающейся хромоты (ПХ)
    year: 2025
    url: https://cr.minzdrav.gov.ru/view-cr/958_1
  - tier: guideline
    org: minzdrav-rf
    title: Критическая ишемия нижних конечностей (КИНК)
    year: 2025
    url: https://cr.minzdrav.gov.ru/view-cr/1016_1
  - tier: guideline
    org: minzdrav-rf
    title: Острая ишемия конечностей
    year: 2025
    url: https://cr.minzdrav.gov.ru/view-cr/1006_1
  - tier: guideline
    org: minzdrav-rf
    title: Флебит и тромбофлебит поверхностных сосудов
    year: 2024
    url: https://cr.minzdrav.gov.ru/view-cr/668_2
  - tier: reference
    org: msd-manuals
    title: Thromboangiitis Obliterans (Buerger Disease) (MSD Manual Professional Version)
    year: 2025
    url: https://www.msdmanuals.com/professional/cardiovascular-disorders/peripheral-arterial-disorders/thromboangiitis-obliterans
  - tier: reference
    org: msd-manuals
    title: Thromboangiitis Obliterans (Buerger Disease) (MSD Manual Consumer Version)
    year: 2025
    url: https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/peripheral-arterial-disease/thromboangiitis-obliterans
  - tier: reference
    org: msd-manuals
    title: Acute Limb Ischemia (MSD Manual Professional Version)
    year: 2025
    url: https://www.msdmanuals.com/professional/cardiovascular-disorders/peripheral-arterial-disorders/acute-limb-ischemia
sources_checked: 2026-10-14
review: null
---

Thromboangiitis obliterans (Buerger disease) is an inflammatory disease in which blood clots form in the small and medium-sized arteries of the arms and legs, and sometimes in the superficial veins. The arteries close up, and the fingers and toes, feet or hands do not get enough blood.<Cite n={[5, 6]} /> Its ICD-10 code is I73.1; it is included in the Russian Ministry of Health guideline on chronic lower limb ischaemia.<Cite n={1} /> It is one of the diseases that block the leg arteries and are much rarer than [atherosclerosis of the leg arteries](../peripheral-artery-disease/), and it has its own risk factors.<Cite n={2} />

Almost all the details about the disease in this article come from the MSD Manual: the Russian Ministry of Health guidelines this article draws on mention Buerger disease only briefly.

<Diagram name="thromboangiitis-obliterans">
  <p slot="normal">
    The diagram shows the arteries of the lower leg and foot, down to the small arteries of the
    toes. It is the small and medium-sized arteries at the ends of the arms and legs that are
    affected in thromboangiitis obliterans; normally they are open inside, and blood reaches the
    toes.<Cite n={5} />
  </p>
  <p slot="disease">
    According to MSD, angiography shows a typical picture: several short blocked segments in the
    distal arteries of the feet and hands, tortuous "corkscrew" bypass (collateral) vessels around
    them, and no signs of atherosclerosis.<Cite n={5} /> Blood flow to the toes is greatly reduced,
    and the foot is cold and may turn bluish or greyish.<Cite n={6} />
  </p>
</Diagram>

## Why it happens

<Patient>

The exact cause is unknown.<Cite n={[5, 6]} /> The main risk factor is smoking: the Russian Ministry of Health guideline names it as the main risk factor for Buerger disease.<Cite n={2} /> According to MSD, the disease occurs almost exclusively in people who use tobacco, and nearly all of them smoke.<Cite n={5} /> Even so, only a few people who smoke develop it. One theory is that smoking triggers inflammation and narrowing of the arteries; another is that the disease is caused by the body's own immune system.<Cite n={6} />

According to MSD, it mostly affects men aged 30–45, and it is rare in women. It is most common in Asia and the Middle East, where tobacco use is heavy.<Cite n={5} />

</Patient>

<Student>

The Russian Ministry of Health guideline stresses that the risk factors for rare obliterative diseases of the lower limb arteries differ from those for atherosclerosis, and regards smoking as the main risk factor for thromboangiitis obliterans.<Cite n={2} />

Pathology (MSD). The inflammation is segmental: it affects small and medium-sized arteries of the extremities and, frequently, the superficial veins.<Cite n={5} /> In the acute phase, occlusive thrombi fill the lumen, the intima is infiltrated by neutrophils and lymphocytes, and endothelial cells proliferate, but the internal elastic lamina remains intact. In the intermediate phase, the thrombi organise and recanalise incompletely. In older lesions, periarterial fibrosis may occur, sometimes involving the adjacent vein and nerve.<Cite n={5} />

The mechanism involves oxidative stress; delayed hypersensitivity and toxic angiitis are proposed, as is an autoimmune origin: cell-mediated sensitivity to types I and III collagen of the vessel wall.<Cite n={5} />

</Student>

## Symptoms

<Patient>

The disease starts gradually, in the most distant parts of the arms and legs, with coldness, numbness, tingling or burning.<Cite n={5} /> These sensations start at the fingertips or toes and spread upwards; the legs are affected more often than the arms.<Cite n={6} /> Raynaud phenomenon is common.<Cite n={5} />

Walking may bring on pain, called intermittent claudication, usually in the arch of the foot or in the lower leg, and rarely in the hand, arm or thigh. Over time the pain may also come on at rest.<Cite n={5} />

Some people have bouts of inflammation of the superficial veins that appear first in one place and then in another, usually on the foot or lower leg (migratory phlebitis).<Cite n={[5, 6]} /> Inflammation of the superficial veins is covered in the article on [superficial thrombophlebitis](../superficial-thrombophlebitis/).

Later, most people develop ulcers that may progress to gangrene (death of tissue), usually of one or more fingers or toes.<Cite n={[5, 6]} /> The foot or hand is cold and may turn bluish or greyish, probably because blood flow is greatly reduced.<Cite n={6} />

</Patient>

<Student>

Pulses are weak or absent in one or more arteries of the foot, and often at the wrist. Affected hands, feet or digits often turn pale when raised and red when hanging down (pallor with elevation, rubor with dependency).<Cite n={5} /> Ischaemic ulcers and gangrene, usually of one or more digits, may appear early in the disease, but not acutely.<Cite n={5} /> When pain is severe and persistent, the leg feels cold, sweats excessively and becomes cyanotic, probably because of sympathetic nerve overactivity.<Cite n={5} />

The Russian Ministry of Health guideline on superficial thrombophlebitis notes that migratory thrombophlebitis may be a manifestation of Buerger disease.<Cite n={4} />

</Student>

## How it is diagnosed

<Patient>

A doctor usually suspects the disease from the symptoms and the examination: in most people the pulse in the arteries of the feet or wrists is weak or cannot be felt.<Cite n={6} /> Ultrasound shows that blood pressure and blood flow in the feet, toes, hands and fingers are greatly reduced.<Cite n={6} />

Blood tests and imaging, including an ultrasound of the heart (echocardiography), are done to rule out other causes of poor blood flow, such as inflammation of the blood vessels (vasculitis) or blood clots that have come from the heart.<Cite n={6} /> Angiography helps confirm the diagnosis: it shows a typical pattern of narrowing. Sometimes a biopsy of an artery or a specialist opinion is needed.<Cite n={6} />

</Patient>

<Student>

According to MSD, the diagnosis is clinical, but other causes of ischaemia must be excluded by testing.<Cite n={5} /> The diagnosis is confirmed when:

- the ankle-brachial index (for the legs) or segmental pressures (for the arms) indicate distal ischaemia;
- echocardiography excludes cardiac emboli;
- blood tests (antinuclear antibodies, rheumatoid factor, complement, anticentromere antibodies, anti-Scl-70 antibodies) exclude vasculitis;
- testing for antiphospholipid antibodies excludes antiphospholipid syndrome (in thromboangiitis obliterans their levels may be slightly raised);
- angiography shows segmental occlusions of the distal arteries of the hands and feet, tortuous corkscrew collaterals around the occlusions and no atherosclerosis.<Cite n={5} />

In young men who smoke and have ulcers on the extremities, a positive Allen test suggests the diagnosis: the hand stays pale after the examiner compresses the radial and ulnar arteries at the same time and then releases them one at a time.<Cite n={5} />

</Student>

## How it is treated

<Patient>

The main treatment is to stop smoking and all other forms of tobacco straight away and completely.<Cite n={[5, 6]} /> If smoking continues, the disease inevitably progresses to severe ischaemia, and amputation is often needed.<Cite n={5} /> If smoking stops, the outlook, according to MSD, is excellent, and amputation is rarely needed.<Cite n={[5, 6]} />

For diseases of the leg arteries, the Russian Ministry of Health guideline advises a combined approach to quitting: behaviour change methods and treatment of nicotine dependence. The doctor chooses the approach.<Cite n={1} />

It is important to protect the hands and feet: avoid cold, burns, and chemical and mechanical injuries, especially from poorly fitting shoes.<Cite n={5} /> Comfortable shoes with plenty of room for the toes help.<Cite n={6} /> The MSD Manual advises avoiding products that narrow the blood vessels; such substances are found even in some remedies for a blocked nose and colds, so it is best to discuss any medicines with a doctor.<Cite n={[5, 6]} />

Sometimes a doctor prescribes medicines, but there is little evidence that most of them help.<Cite n={5} /> If ischaemia threatens the limb, blood flow may be restored through a puncture in an artery or by open surgery; the doctor decides on this.<Cite n={[5, 6]} />

</Patient>

<Student>

According to MSD, treatment is centred on stopping tobacco use. In addition: avoiding cold, medicines that can cause vasoconstriction, and thermal, chemical and mechanical injury, especially from poorly fitting footwear; sometimes drug therapy.<Cite n={5} /> In chronic limb-threatening ischaemia, endovascular or surgical revascularisation, according to MSD, appears to have a reasonable safety profile and outcomes.<Cite n={5} /> Sympathectomy is seldom done, because it usually improves blood flow only temporarily.<Cite n={6} />

The Russian Ministry of Health guideline strongly recommends that all patients with lower limb artery disease who smoke or use tobacco in another form stop, to reduce the risk of cardiovascular complications and disease progression. This recommendation applies to all such diseases, not only to Buerger disease.<Cite n={1} />

</Student>

## When to call an ambulance

Thromboangiitis obliterans usually develops gradually, but the Russian Ministry of Health guideline lists it among the rare causes of acute ischaemia of the leg.<Cite n={[3, 6]} /> Acute limb ischaemia is a sudden loss or reduction of blood flow to a limb that threatens the limb and needs urgent diagnosis and treatment.<Cite n={3} /> Call your local emergency number (112 in the EU, 911 in the US and Canada, 999 in the UK) straight away if a leg or an arm suddenly becomes very painful, pale, cold, numb or tingling, or weak or impossible to move, or if the pulse has disappeared.<Cite n={7} /> More in the article on [acute limb ischaemia](../acute-limb-ischemia/).

Seek medical help urgently if you have sores or ulcers on the foot that do not heal or heal too slowly, if the leg is very painful or numb at rest, or if parts of the foot have turned black (gangrene): these may be signs of critical ischaemia.<Cite n={2} /> Do not put off seeing a doctor if ulcers appear on the fingers or toes or if they turn bluish or greyish: this may be a sign of greatly reduced blood flow.<Cite n={6} />

As with any heart condition, call an ambulance for fainting, chest pain or severe shortness of breath: this is the site's general safety rule, repeated at the bottom of every page.

<Quiz />