Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients Caregivers Providers
Log In Ask a Question
PubMed This is a summary of 26 peer-reviewed journal articles Updated
Vascular Surgery

Managing Buerger Disease: Standard of Care and Beyond

At a Glance

The absolute foundation of treating Buerger disease is the complete cessation of all tobacco, nicotine, and cannabis use. For persistent symptoms, treatments include medications like iloprost to open vessels, surgical bypass, and emerging stem cell therapies to improve blood flow.

The treatment of Buerger disease is unique because it centers almost entirely on one lifestyle change. While many vascular conditions rely heavily on surgery or long-term medication, Buerger disease is an inflammatory reaction that can often be “turned off” by removing the trigger. However, for those with advanced disease or severe pain, doctors have several medical and surgical tools to help manage symptoms and protect the limbs.

The Absolute Foundation: Smoking Cessation

The most critical, mandatory, and definitive treatment for Buerger disease is the total and permanent cessation of all tobacco, nicotine, and cannabis products [1][2][3].

  • Why it is mandatory: Tobacco and cannabis are the “fuel” for the inflammation in your vessels. As long as these are in your system, the disease will likely continue to progress, leading to a high risk of amputation [4][5][3].
  • The Goal: Complete abstinence. This includes cigarettes, cigars, chewing tobacco, vaping, and even nicotine replacement therapies (like patches or gum), as nicotine itself triggers the inflammatory response [1][6].

Non-Nicotine Smoking Cessation Aids

Because nicotine replacement therapies (patches, gum) are unsafe for Buerger patients, you must quit without these standard aids. However, non-nicotine prescription medications (like bupropion or varenicline) and behavioral therapies are highly effective options that you should discuss with your doctor immediately [7][8].

Medical Therapies for Blood Flow

If you have stopped smoking but still experience pain or have non-healing sores, your doctor may prescribe medications to improve blood flow:

  • Iloprost: This is a prostacyclin analogue often given through an IV. It helps dilate (open) blood vessels and prevents blood from clotting, which can significantly reduce pain and help heal ulcers [9][10].
  • Cilostazol: This medication is used to help with claudication (pain when walking). It works by widening the arteries and reducing the inflammation that makes vessel walls “sticky” [11][12].
  • Anti-platelet agents: You may be prescribed aspirin or other blood thinners to prevent further clots from forming in the narrowed vessels [9][10].

Surgical and Endovascular Options

Restoring blood flow to the limbs (revascularization) in Buerger disease is technically challenging because the blockages often occur in very small vessels near the hands and feet [13][14].

  • Endovascular Therapy: Doctors use thin tubes (catheters) and tiny balloons or stents to open blocked arteries from the inside [15][14]. This is often the first choice because it is less invasive, though it may require more frequent “tune-ups” or re-interventions [15][16].
  • Surgical Bypass: If a long section of an artery is blocked, a surgeon may use a piece of your own vein to “bypass” the blockage [16][17]. This is difficult in Buerger disease because there are often few healthy “landing spots” for the new graft in the small vessels of the foot or hand [18].

Emerging Options for “No-Option” Patients

If traditional surgical interventions are not possible, you may be referred to as a “no-option” patient. For these cases, new regenerative therapies are being explored, primarily through clinical trials:

  • Stem Cell Therapy: Using autologous bone marrow-derived mononuclear cells (your own cells) injected into the limb can help stimulate the growth of new, tiny blood vessels [19][20]. Studies show this can help heal ulcers and prevent amputation in severe cases, though access is largely limited to clinical trials [21][22].
  • Gene Therapy: Scientists are using VEGF (Vascular Endothelial Growth Factor) to signal the body to create new blood vessels, a process called therapeutic angiogenesis, which is also an experimental approach [23][24].
  • Vein Arterialization: In extreme cases, surgeons can sometimes “rewire” a vein to carry oxygenated blood to the foot, bypassing the blocked arteries entirely [18].

Supportive Care

Beyond medications and surgery, you can protect your limbs by:

  • Avoiding Cold: Cold temperatures cause vessels to constrict (narrow), worsening the pain.
  • WARNING: Never Apply Direct Heat: Patients with cold, painful limbs often try to warm them using heating pads, space heaters, or hot water bottles. Do not do this. Because your blood flow is compromised and you may have nerve damage, the heat cannot dissipate, which frequently results in severe, limb-threatening burns [6][25]. Always warm up by adding layers of clothing instead.
  • Meticulous Foot Care: Check your feet daily for any small cuts or blisters, as these can quickly turn into serious ulcers [6].
  • Exercise Therapy: Supervised walking programs can help train your body to use what blood flow it has more efficiently [26].

Common questions in this guide

Can I use nicotine patches to quit smoking if I have Buerger disease?
No, nicotine replacement therapies like patches or gum are unsafe for people with Buerger disease. Nicotine itself triggers the inflammatory response that blocks your blood vessels, so you must use non-nicotine prescription medications or behavioral therapies to quit.
What medications are used to improve blood flow in Buerger disease?
Doctors may prescribe medications like iloprost, which is given through an IV to help dilate blood vessels and heal ulcers. Cilostazol can also be used to widen arteries and reduce pain when walking, along with anti-platelet agents to prevent new clots.
Is surgery an option to treat Buerger disease?
Surgical options like endovascular therapy (using balloons or stents) or surgical bypass can help restore blood flow. However, surgery can be challenging because Buerger disease typically blocks the very small blood vessels near the hands and feet.
What are the options if standard surgery won't work for my Buerger disease?
If standard surgery is not possible, you may be eligible for clinical trials exploring new regenerative treatments. These include stem cell therapies and gene therapies designed to stimulate the growth of new, tiny blood vessels in the affected limbs.
How should I warm my cold hands or feet?
You should warm your limbs only by adding extra layers of clothing. Never apply direct heat sources like heating pads, space heaters, or hot water bottles. Because your blood flow is compromised, the heat cannot dissipate, which frequently results in severe burns.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.If I stop using tobacco completely right now, what is the likelihood that my current symptoms will stabilize or reverse?
  2. 2.Am I a candidate for Iloprost or Cilostazol to help improve my circulation and reduce pain?
  3. 3.Based on my imaging, am I eligible for an endovascular procedure or a bypass, or are my blocked vessels too small?
  4. 4.If traditional surgery isn't an option for me, are there any clinical trials or stem cell therapies I should consider?
  5. 5.What is your experience in performing revascularization on Buerger disease patients specifically, given how different it is from standard artery disease?
  6. 6.Are there specific non-nicotine smoking cessation medications you recommend or can prescribe for me?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (26)
  1. 1

    [Thromboangiitis obliterans: notions for practice].

    Calanca L, Alatri A, Krieger C, et al.

    Revue medicale suisse 2017; (13(586)):2129-2133.

    PMID: 29211372
  2. 2

    Thromboangiitis obliterans (Buerger's disease).

    Rivera-Chavarría IJ, Brenes-Gutiérrez JD

    Annals of medicine and surgery (2012) 2016; (7()):79-82 doi:10.1016/j.amsu.2016.03.028.

    PMID: 27144003
  3. 3

    Serum heavy metal levels from tobacco smoke and Buerger's disease.

    Asadollahi Shahir AA, Khoshakhlagh AH, Mehrzad F, et al.

    Scientific reports 2025; (15(1)):40821 doi:10.1038/s41598-025-24542-2.

    PMID: 41258278
  4. 4

    Long-Term Outcome and Prognostic Factors of Complications in Thromboangiitis Obliterans (Buerger's Disease): A Multicenter Study of 224 Patients.

    Le Joncour A, Soudet S, Dupont A, et al.

    Journal of the American Heart Association 2018; (7(23)):e010677 doi:10.1161/JAHA.118.010677.

    PMID: 30571594
  5. 5

    A Non-smoking Woman with Anti-phospholipid Antibodies Proved to Have Thromboangiitis Obliterans.

    Shima N, Akiyama Y, Yamamoto S, et al.

    Internal medicine (Tokyo, Japan) 2020; (59(3)):439-443 doi:10.2169/internalmedicine.3372-19.

    PMID: 31588083
  6. 6

    Pathogenesis and Management of Buerger's Disease.

    Liew NC, Lee L, Nor Hanipah Z, et al.

    The international journal of lower extremity wounds 2015; (14(3)):231-5 doi:10.1177/1534734615599654.

    PMID: 26264874
  7. 7

    The Effect of Smoking Cessation on the Technical Success of Endovascular Treatment for Thromboangiitis Obliterans.

    Gundogmus CA, Samadli V, Sorkun M, Oguzkurt L

    Journal of vascular and interventional radiology : JVIR 2023; (34(6)):1038-1044 doi:10.1016/j.jvir.2023.02.008.

    PMID: 36791958
  8. 8

    Demographic Traits, Clinical Status, and Comorbidities of Patients With Thromboangiitis Obliterans in Japan.

    Watanabe Y, Shimizu Y, Hashimoto T, et al.

    Circulation journal : official journal of the Japanese Circulation Society 2024; (88(3)):319-328 doi:10.1253/circj.CJ-23-0211.

    PMID: 37423757
  9. 9

    Successful sequential drug eluting balloon angioplasty to chronic total occluded popliteal artery in a patient with thromboangitis obliterans by PCR.

    Kaçmaz F, Kaya A, Yazıcı A

    Anatolian journal of cardiology 2016; (16(6)):450-1 doi:10.14744/AnatolJCardiol.2016.6979.

    PMID: 27282675
  10. 10

    Conservative treatment of patients with thromboangiitis obliterans or cannabis-associated arteritis presenting with critical lower limb ischaemia.

    Galyfos G, Kerasidis S, Kastrisios G, et al.

    VASA. Zeitschrift fur Gefasskrankheiten 2017; (46(6)):471-475 doi:10.1024/0301-1526/a000649.

    PMID: 28753096
  11. 11

    Cilostazol on the expression of ICAM-1, VCAM-1 and inflammatory factors in plasma in patients with thromboangiitis obliterans.

    Song F, Ji B, Chen T

    Experimental and therapeutic medicine 2018; (16(3)):2349-2354 doi:10.3892/etm.2018.6436.

    PMID: 30186478
  12. 12

    Do Patients With Arterial Occlusive Disease of Different Etiologies Benefit Equally From Cilostazol?

    Can Depboylu B, Yazman S, Harmandar B, et al.

    Texas Heart Institute journal 2023; (50(1)) doi:10.14503/THIJ-21-7747.

    PMID: 36763036
  13. 13

    [Thromboangiitis obliterans (Buerger's disease): state of the art].

    Zerbino DD, Zimba EA, Bagry NN

    Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery 2016; (22(4)):185-192.

    PMID: 27935900
  14. 14

    A systematic review and meta-analysis of early and late outcomes after endovascular angioplasty among patients with thromboangiitis obliterans and chronic limb ischemia.

    Galyfos G, Liakopoulos D, Chamzin A, et al.

    Journal of vascular surgery 2023; (77(5)):1534-1541.e2 doi:10.1016/j.jvs.2022.09.017.

    PMID: 36174815
  15. 15

    Outcomes of endovascular recanalization versus autogenous venous bypass for thromboangiitis obliterans patients with critical limb ischemia due to tibioperoneal arterial occlusion.

    Ye K, Shi H, Qin J, et al.

    Journal of vascular surgery 2017; (66(4)):1133-1142.e1 doi:10.1016/j.jvs.2017.03.425.

    PMID: 28697938
  16. 16

    Immediate and late outcomes of endovascular therapy for lower extremity arteries in Buerger disease.

    Kim DH, Ko YG, Ahn CM, et al.

    Journal of vascular surgery 2018; (67(6)):1769-1777 doi:10.1016/j.jvs.2017.09.020.

    PMID: 29157680
  17. 17

    Outcomes of endovascular treatment versus bypass surgery for critical limb ischemia in patients with thromboangiitis obliterans.

    Lee CY, Choi K, Kwon H, et al.

    PloS one 2018; (13(10)):e0205305 doi:10.1371/journal.pone.0205305.

    PMID: 30300407
  18. 18

    Transcatheter arterialization of deep veins in a patient with no-option CLTI with thromboangiitis obliterans: A case report.

    Asano K, Nakama T, Kojima S, Obunai K

    Journal of cardiology cases 2026; (33(1)):31-35 doi:10.1016/j.jccase.2025.10.004.

    PMID: 41550627
  19. 19

    Long-Term Clinical Outcomes Survey of Bone Marrow-Derived Cell Therapy in Critical Limb Ischemia in Japan.

    Kondo K, Yanishi K, Hayashida R, et al.

    Circulation journal : official journal of the Japanese Circulation Society 2018; (82(4)):1168-1178 doi:10.1253/circj.CJ-17-0510.

    PMID: 29386474
  20. 20

    Therapeutic Angiogenesis Using Bone Marrow-Derived Mononuclear Cell Implantation for Patients With Critical Limb-Threatening Ischemia Caused by Thromboangiitis Obliterans　- Study Protocol for a Multicenter Prospective Interventional Trial.

    Fujioka A, Yanishi K, Shoji K, et al.

    Circulation reports 2020; (2(10)):630-634 doi:10.1253/circrep.CR-20-0086.

    PMID: 33693187
  21. 21

    Long-Term Clinical Outcomes of Autologous Bone Marrow Mononuclear Cell Implantation in Patients With Severe Thromboangiitis Obliterans.

    Mohamad Yusoff F, Kajikawa M, Takaeko Y, et al.

    Circulation journal : official journal of the Japanese Circulation Society 2020; (84(4)):650-655 doi:10.1253/circj.CJ-19-1041.

    PMID: 32132348
  22. 22

    Autologous bone marrow-derived mononuclear cell therapy in Chinese patients with critical limb ischemia due to thromboangiitis obliterans: 10-year results.

    Guo J, Guo L, Cui S, et al.

    Stem cell research & therapy 2018; (9(1)):43 doi:10.1186/s13287-018-0784-6.

    PMID: 29471870
  23. 23

    Gene Therapy of Thromboangiitis Obliterans with Growth Factor Plasmid (VEGF165) and Autologous Bone Marrow Cells.

    Barć P, Lubieniecki P, Antkiewicz M, et al.

    Biomedicines 2024; (12(7)) doi:10.3390/biomedicines12071506.

    PMID: 39062079
  24. 24

    Therapeutic Angiogenesis Using Bone Marrow Mononuclear Cell Transplantation　- A New Standard Treatment for Thromboangiitis Obliterans?

    Shibata R, Yamaguchi S, Murohara T

    Circulation journal : official journal of the Japanese Circulation Society 2020; (84(4)):549-550 doi:10.1253/circj.CJ-20-0137.

    PMID: 32173685
  25. 25

    Clinical Presentation and Treatment of Thromboangiitis Obliterans With Superimposed Osteomyelitis.

    Kidron A, Daahir C

    Cureus 2022; (14(1)):e21423 doi:10.7759/cureus.21423.

    PMID: 35198328
  26. 26

    Efficacy of Supervised Exercise Therapy for Intermittent Claudication in a Case With Buerger's Disease.

    Komiya D, Iwai K, Ohno T

    Cureus 2023; (15(8)):e43537 doi:10.7759/cureus.43537.

    PMID: 37719627

This page provides educational information about Buerger disease treatments. It is not a substitute for professional medical advice; always consult your vascular specialist regarding your specific care plan.

Get notified when new evidence is published on Buerger disease.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.