Buerger's disease revisited.

TAO is a distinct, pathologic, and clinical disease process. Its diagnosis can be arrived at with a reasonable degree of certainty by the clinical history, angiographic findings, and pathology. Tobacco plays a very important part in the etiology of the disease process and must be completely avoided in any form for successful treatment. Four-extremity arteriography is recommended to assess the present nature of the disease and for a comparison at a later date. Direct arterial surgery is seldom feasible because of the distal and segmental nature of TAO. Sympathectomy can be helpful if combined with elimination of tobacco and quiescence of the disease. Meticulous local therapy to the ischemic tissue with control of infection and precise amputation if necessary is extremely important.