Buerger’s disease is caused by vas-culitis, an inflammation of blood vessels. Polymorphonuclear leukocytes infiltrate the vessel walls, and thrombi develop in the vascular lumen. As the disease progresses, mononuclear cells, fibroblasts, and giant cells replace the neutrophils. In later stages, perivascular fibrosis and recanalization occur.

This disorder affects the legs more commonly than the arms. Cerebral, visceral, and coronary vessels also may be affected.

Buerger’s disease occurs in 6 of every 10,000 people and is most common among men ages 20 to 40 with a history of smoking or chewing tobacco. Affected people also may have a history of Raynaud’s disease or autoimmune disease.

Buerger’s disease typically produces intermittent claudication of the instep that’s worsened by exercise and relieved by rest. In low temperature, the feet initially become cold, cyanotic, and numb; later, they redden, become hot, and tingle. Occasionally, Buerger’s disease affects the hands and may cause painful fingertip ulcerations, severe digital ischemia, trophic nail changes, and gangrene. Other signs and symptoms may include impaired peripheral pulses, migratory superficial thrombophlebitis and, in later stages, ulceration, muscle atrophy, and gangrene.