Introduction A nonatherosclerotic, segmental, inflammatory disease in the small and medium-sized vessels of the hands and feet occurs predominantly in smokers Epidemiology Incidence 12.6 per 100,000 in the United States Demographics 3:1 male: female ratio typically affects patients < 45 years old Risk factors smoking chewing tobacco Etiology Pathophysiology inflammation and clotting of the small vessels of hands and feet 3 phases acute login to view 1 more bullet subacute login to view 1 more bullet chronic login to view 2 more bullets Presentation Symptoms early disease intermittent claudication of feet, legs, hands or arms numbness and/or tingling in the limbs late disease symptoms of critical limb ischemia login to view 1 more bullet Physical exam inspection ulcerations large, erythematous, superficial blood vessels necrotic distal digits in hands and feet palpation decreased temperature in hands and feet neurovascular diminished or absent pulses sensory findings in up to 70% of patients provocative tests positive Allen test in young smoker with digital ischemia is suggestive of disease Imaging Arteriography indications useful for ruling-out other conditions that may mimic Buerger's disease findings "corkscrew" vessels collateral circulation giving a "spider leg" appearance Studies Labs used to exclude alternative diagnoses Echocardiogram used to exclude proximal source of emboli Treatment Nonoperative smoking cessation and symptomatic treatment indications login to view 1 more bullet techniques login to view 9 more bullets outcomes login to view 1 more bullet Operative surgical sympathectomy indications (controversial) login to view 1 more bullet technique login to view 1 more bullet amputation indications login to view 3 more bullets Prognosis Depends on smoking status 94% who quit smoking avoid amputation 43% chance of amputation within 8 years if smoking is continued