Ultrasonographic Study of the Corkscrew Arterial Image in Buerger Disease Patients.

Objective: Thromboangiitis obliterans (Buerger disease) is known as an intractable vascular disease that has been reported as thrombosis in distal arteries and occasional venous occlusion, as well as inflammatory changes in the thrombus and vascular wall. Patients often require limb amputation due to limb necrosis. Corkscrew (CS), a small arterial coiling, is an important diagnostic finding that was mainly found with angiography. Recently, however, it can also be identified using a modern ultrasonographic technique. Methods: In these 22 cases, in 48 areas of study, we used the ultrasonographic technique to identify the CS, which allowed us to observe its relationship with the surrounding nerves and arteries. Results: In all cases, it was possible to identify the CS easily and it was confirmed that the CS and the nerve were carried down in their sheath. The sites of the CS existed in areas other than the area around the occluded main arteries and some CS that ran inside the nerve (16 areas) and some CS that accompanied the outside of the nerve (10 areas) were confirmed, suggesting the CS work as collateral blood supply vessels, with well-developed normal vessel-like anatomy. Conclusion: When we observe the CS, it is important to observe not only around the main trunk artery but also areas where nerves mainly run, even if they do not accompany the main trunk artery. (This is a translation of Jpn J Vasc Surg 2023; 32: 345-350.).

Mesenchymal stromal cell therapy (REGENACIP®), a promising treatment option in chronic limb threatening ischemia - a narrative review.

Chronic Limb Threatening Ischemia (CLTI) is a challenging clinical problem associated with high morbidity and mortality. Endovascular interventions have been the cornerstone of treatment whenever possible. It is estimated that CLTI represents < 10% of all Peripheral Artery Disease patients, yet 50% of the patients end up either with a major amputation of the lower limbs or die of cardiovascular causes within one year period, especially in those with unsuccessful revascularization or "no-option" CLTI. Cell-based therapeutics, especially bone marrow-derived mesenchymal stromal cells have emerged as a potential, promising, and novel alternate therapeutic modality in the management of CLTI, bolstered with positive results in numerous research, including randomized and nonrandomized trials. REGENACIP® is one such BM-MSC therapy approved by Central Drugs Standard Control Organization in India for the management of "no-option" Atherosclerotic Peripheral Arterial disease / Buerger's disease patients with established critical limb ischemia in Rutherford Grade III-5 or III-6, not eligible for or have failed traditional revascularization treatment, with rest pain and / or ulcers in the affected limb. The current review aims to deliberate upon the various aspects of CLTI and clinical benefits of REGENACIP® therein.

Effect of Buerger's disease on ocular microvascular structure.

CLINICAL RELEVANCE: Buerger's disease, being a systemic inflammatory vasculopathy, may present with ocular findings. BACKGROUND: This study aims to understand the potential role of optical coherence tomography and angiography findings in evaluating the course of Buerger's disease. METHODS: This was a prospective, cross-sectional study that included 25 patients with Buerger's disease (Group 1) and 51 healthy control participants, of whom 27 were smokers (Group 2) and 24 were non-smokers (Group 3). Following a detailed ophthalmic examination, optical coherence tomography and angiography measurements were conducted on participants. The values of macular superficial and deep capillary plexus, peripapillary capillary plexus vessel density measurements were taken into account from optical coherence tomography angiography measurements. Furthermore, measurements were taken for the parameters of the foveal avascular zone, including its area, perimeter and acircularity index. Additionally, the choriocapillaris flow area was assessed between radii of 1 mm, 2 mm, and 3 mm. RESULTS: In patients with Buerger's disease, the area and perimeter of the foveal avascular zone were higher than in both smoker and non-smoker healthy groups (p < 0.001 for all). The vessel densities in superficial capillary plexus were found to be lower in patients with Buerger's disease compared to both smokers and non-smokers in all regions except the parafovea (p < 0.05 for all). The radial peripapillary capillary plexus vessel densities in the whole retina and peripapillary region were lower than those in the non-smoker group (p < 0.001 and p = 0.008). The choriocapillaris flow areas in all three radius were lower in the smoker group than in the non-smoker group (1 mm, p = 0.01; 2 mm, p = 0.005; 3 mm, p = 0.011). CONCLUSIONS: Buerger's disease extends beyond the extremities, affecting vascular density and tissue perfusion in the optic disc and macula, making it a systemic condition. This disease can have ocular involvement without causing serious ocular findings.

A case of Buerger's disease with vasculopathy and skin fibrosis requiring differential diagnosis from systemic sclerosis.

Buerger's disease is characterized by peripheral ischemia due to occlusion of small- and medium-sized arteries in the extremities. This report describes a case of Buerger's disease in a 51-year-old male who presented with findings resembling systemic sclerosis. The patient exhibited Raynaud's phenomenon in year X-3, which developed to skin hardening, nail avulsion, and ulceration of the right fingers in year X. Diagnostic testing showed positive microvasculopathy on nailfold videocapillaroscopy (NVC) and positive fibrosis on skin biopsy. Although the patient fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for systemic sclerosis, several findings in this case were atypical for systemic sclerosis, including left-right asymmetry in finger involvement, nail loss, and negative autoantibody tests. Contrast-enhanced computed tomography showed poor perfusion of the right ulnar artery, and a heavy smoking history was established in the patient case. Therefore, based on Shionoya's criteria, he was diagnosed with a case of Buerger's disease confined to the upper extremity. Smoking cessation and vasodilator therapy resulted in the prompt resolution of ischemic symptoms, skin hardening, and ulcerations. Furthermore, NVC abnormalities improved, and ulnar artery occlusion showed reperfusion on repeat testing. The present case suggests that hypoxemia-driven microvasculopathy may contribute to vascular occlusion and skin fibrosis observed in this atypical presentation.

[Is this iatrogenic pathology or rare disease?] / Yatrogennaya patologiya ili redkaya bolezn'?

The article is devoted to the problem of diagnosis and treatment strategy of Buerger's disease rarely found in the expert and clinical practice, that is inflammatory disease of unknown etiology, affecting mainly small and medium arteries and veins of limbs. Vascular surgeons around the world have been solving this problem for many years, both in terms of timely diagnosis of this disease and its proper pathogenic treatment. The authors of the article described an expert case of Buerger's disease larvated course in 15-years-old girl, which primarily was mistakenly assessed by specialists as iatrogenic pathology of right forearm vessels in injecting aminazin solution that, according to the clinicians' opinion, led to dry gangrene formation of right wrist and its subsequent amputation. The results of the forensic histological study and retrospective analysis of all child's medical documents allowed to correctly diagnose this rare pathology but only on the stage of commission forensic medical examination in the framework of the initiated criminal proceeding against several leading medical organizations in Saint-Petersburg with a pediatric profile. The authors noted the role of routine medical manipulation in manifestation of larvated pathologic process in a teenage girl in addition to full health and well-being. The objective of present article is devoted to understanding this problem.

Short-term efficacy of endovascular procedures for lower extremity thromboangiitis obliterans (Buerger's disease).

PURPOSE: Although thrombolysis obliterans (TAO) has been recognized for more than a century, there is no optimal treatment for this disease. The aim of this report was to compare the short-term efficacies of catheter-directed thrombolysis (CDT), percutaneous transluminal angioplasty (PTA) and CDT+PTA in treating TAO disease. METHOD: Consecutive patients with TAO treated at Ganzhou People's Hospital between 2012 and 2022 were included in this retrospective study. According to the information provided in the medical records, endovascular procedures included CDT, PTA or CDT+PTA. One-year follow-up outcomes of the patients with TAO who underwent endovascular procedures were compared. The primary outcome was major adverse limb event (MALE) and the secondary outcomes were the technical success, complications, ABI at 1 week after surgery and minor amputation. RESULTS: Sixty-nine patients with TAO were assessed for inclusion in our single-center study from 2012 to 2022 and received endovascular procedures. Among them, 22 patients underwent CDT, 21 patients underwent PTA, and 26 patients underwent PTA+CDT. The one-year follow-up revealed significant differences in the MALE-free survival rates among the three groups, particularly between the CDT group and the PTA+CDT group (the hazard ratio (HR) for MALE-free survival was 0.173, 95% CI [0.050-0.599], p = 0.006). The technical success rates of the three groups were 63.6%, 90.5%, and 92.3%, respectively. There were differences in the ABI at one week after surgery among the three groups. CONCLUSIONS: Endovascular procedures are effective for TAO in the short term. The effectiveness of CDT alone is suboptimal; combining CDT with PTA achieves the most favorable endovascular treatment outcome; while the effectiveness of PTA falls in between these two procedures.

The Safety and Effectiveness of Interval Stellate Ganglion Neurolysis in a Patient with Bilateral Digital Ischemia of Hands Due to Buerger's Disease: A Case Report.

Introduction: Thromboangiitis obliterans (TAO) or Buerger's disease (BD) is a small and medium-sized arteriovenous segmental occlusive inflammatory disease frequently occurring in men as compared to women. Although a common etiological agent is smoking or tobacco consumption, it has also been reported infrequently in non-smokers. Except for smoking other etiological agents, HLA, autoimmune diseases like systemic lupus erythematosus, and periodontitis have also been suggested. Minimally invasive pain and spine intervention (MIPSI) like stellate ganglion neurolysis with 8% phenol, 10 days apart in patients suffering from bilateral digital ischemia of both hands is a safe and effective treatment. Case Report: Fifty-five-year-old female with chief complaints of burning pain, swelling, and blackening of all five fingers of the right and four fingers of the left hands excluding the thumb for the past 3 months. On examination, pulse was almost absent at the wrist in both hands. There was no history of smoking. Under aseptic precautions, fluoroscopy and radiocontrast guidance stellate ganglion neurolysis with a 22G spinal needle, 2 ml of 8% phenol, 2 ml of 0.25% bupivacaine and 4 mg of dexamethasone were given at C7 vertebral level 10 days apart on both sides. After 3-4 months of stellate ganglion phenol chemical neurolysis, involved fingers were saved except the gangrenous part which was autoamputated itself in due course of time. Conclusion: Bilateral interval (10 days apart) chemical neurolysis of stellate ganglion in Buerger's disease involving both hands is a safe and effective technique in terms of control of disease progression, pain, cardiac complications, and recurrent laryngeal nerve-related complications.

Low-intensity pulsed ultrasound for 'no-option' chronic/critical limb-threatening ischaemia in a patient with Buerger disease: a case report.

Background: Buerger disease, also known as Winiwarter-Buerger disease or thromboangiitis obliterans (TAO), is a non-specific inflammation of small- and medium-sized arteries with thrombus obliteration and without atherosclerotic changes. Patients with TAO can develop chronic limb-threatening ischaemia (CLTI) and are at risk of limb amputation despite smoking cessation and exercise therapy recommendations. Case summary: A 72-year-old Japanese man presented with painful discolouration of toes and renal impairment. He was diagnosed with Rutherford classification Stage 6 CLTI with immunoglobulin A nephropathy. He refused limb amputation. Clinical symptoms reduced after treatment with low-intensity pulsed ultrasound (LIPUS). LIPUS is a non-invasive option to alleviate peripheral arterial disease symptoms. Despite the initiation of conventional therapy measures, there was a worsening of the limb condition. The non-invasive investigational treatment option of LIPUS was initiated after the poor clinical outcomes of the conventional therapy measures. The patient's symptoms in the bilateral lower limbs, ulcers, and the blue-coloured toes gradually lessened. After 1 year of treatment with LIPUS, he had achieved better walking independence with improved quality of life. Discussion: Low-intensity pulsed ultrasound is a non-invasive option for therapeutic angiogenesis with the potential to improve ischaemic limb conditions in patients with peripheral arterial disease and to avoid major amputation procedures.

Spontaneous Intercostal Artery Bleeding in a Patient With Buerger's Disease: A Case Report.

Intercostal artery (ICA) injury and bleeding are well-known complications of thoracic procedures and trauma; however, spontaneous ICA bleeding is a rare condition usually associated with specific underlying disorders that typically lead to the weakening of vasculature. Herein, we present a 42-year-old male with a history of Buerger's disease who developed spontaneous bleeding of the second left ICA after undergoing lower limb angioplasty. The bleeding was complicated by a large hemothorax and retropleural hematoma, resulting in hemorrhagic shock that necessitated massive transfusion, embolization, and eventual thoracotomy with evacuation.

Isolated visceral manifestation of Buerger's disease presenting as intestinal obstruction: a case report.

Introduction and importance: Buerger's disease is an uncommon segmental nonatherosclerotic vasculitis essentially affecting small to medium-sized arteries and veins of upper and lower extremities and can lead to limb amputation. Visceral vessel involvement is quite rare accounting for 2% of cases presenting with acute abdomen due to mesenteric ischemia. Moreover, isolated visceral involvement is even rare. Case presentation: A 42-year-old gentleman, a chronic smoker, presented with abdominal pain associated with nausea and vomiting and loose stool of 2 months duration. Magnetic resonance enterography revealed segmental circumferential wall thickening with stricture in the mid part of the jejunum with lymphadenopathy features of possible inflammatory bowel disease (Crohn's disease). Furthermore, intraoperative surgical findings were also suggestive of Crohn's disease. However, histologic findings were consistent with thromboangiitis obliterans. Discussion: Thromboangiitis obliterans can present with inflammatory vascular lesions without necrosis in the early stage to varying degrees of recanalisation, gangrene, and amputation in the late stage. It rarely involves the brain, heart, and abdominal viscera. The visceral involvement may be in the form of intestinal obstruction or mesenteric ischemia or can mimic Crohn's in a background of smoking. Conclusion: This case report will help to learn more about the rarer intestinal presentation of intestinal Buerger's disease. It can present with features of bowel ischemia, obstruction or Crohn's. So, histology would play a pivotal role in differentiating the diagnostic dilemma.

Critical Limb Ischemia Due to Suspected Buerger's Disease in an Adolescent Patient: A Case Report.

Buerger's disease is a segmental and inflammatory syndrome affecting relatively young individuals primarily and occurs with occlusion of small to medium-sized vessels in their extremities. The typical age for symptoms to appear is between 35 and 50 years in smoking patients. The disease is not manifested in children or the elderly. The only recognized successful treatment for it is immediate termination of smoking. In this report, we describe the case of a 16-year-old male suffering from this condition and referred from the pediatric department to our clinic, followed by a literature review of Buerger's disease reported in adolescent patients.

Buerger's Disease of Hand; my Experience with Phenol Chemical Neurolysis of Stellate Ganglion: Case Series of Six Patients.

Introduction: Buerger's disease is common in 74.70% of cases in the lower limb but in 20.20% of cases, it is found in the upper limb or hand. The disease usually starts from pain in the finger/thumb or hand and then to more centrally.Patients presented with pain in the hand with gangrene of fingers. Pain aggravated on lifting hand above the shoulder level or above heart level in upright or lying in the bed, respectively. Case Report: In almost all patients, there was a history of smoking except one and all patients had involvement of digits of the right or left hand. Diagnosis of Buerger's disease was made based on the history of smoking, weak or absent pulse, lack of bleeding, swelling, edema, blackening, stony hard fingers or thumb on clinical examination, and color Doppler study of the limb.In all patients, Stellate ganglion chemical neurolysis with 8% phenol was done at C7-T1 under fluoroscopic and radiocontrast dye (Iohexol 300) guidance.After successful neurolysis patients got excellent pain relief, their wounds started healing, the vascularity of the diseased part increased and the disease stopped progressing. Conclusion: Stellate ganglion chemical neurolysis with phenol in Peripheral vascular disease or Buerger's disease of hand is an effective method to stop the disease procession, promoting wound healing, controlling ischemic pain, and avoiding surgical amputation.

Effect of Buerger-Allen exercise on wound healing in patients with diabetic foot ulcers: a randomised controlled trial.

OBJECTIVE: A diabetic foot ulcer (DFU) is a complication of type 2 diabetes that is difficult to treat. Buerger-Allen exercise has shown effectiveness in improving foot circulation and neuropathy in several studies; however, to the best of our knowledge, no randomised controlled study has investigated its effectiveness for DFU healing. Therefore, this study aimed to assess the effects of Buerger-Allen exercise on the healing of DFUs in patients with type 2 diabetes. METHOD: This is a parallel-group randomised controlled trial (RCT). Of 50 patients with neuropathic DFUs, 41 completed the study. They were assigned randomly to a study group (n=21) and a control group (n=20). Patients in the study group received the standard medical treatment and semi-supervised Buerger-Allen exercise for three sessions per week for four weeks, while patients in the control group only received the standard medical treatment. The outcome measures were: ankle-brachial pressure index (ABPI); ulcer size; ulcer depth; SINBAD score; and ulcer risk for poor outcomes (based on the SINBAD score). RESULTS: The study group's mean age was 49.48±6.45 years and the control group's mean age was 49.15±5.85. The study group's ABPI increased significantly compared to the baseline (1.17±0.04 versus 1.11±0.05, respectively; p<0.001) and the control group (1.17±0.04 versus 1.14±0.05, respectively; p=0.04) post-intervention. Ulcer size also reduced significantly in the study group compared to the baseline (2.63±2.0 versus 7.48±5.55cm2, respectively; p<0.001) and the control group (2.63±2.0 versus 6.43±4.45cm2, respectively; p<0.001) post-intervention. Ulcer depth decreased significantly in the study group compared to the baseline (1.71±1.05 versus 4.19±1.74mm, respectively; p<0.001) and the control group (1.71±1.05 versus 2.80±1.57mm, respectively; p=0.01) post-intervention. Furthermore, the SINBAD score in the study group decreased significantly compared to the baseline (1.38±0.86 versus 2.14±1.06, respectively; p<0.001) and the control group (1.38±0.86 versus 2.0±0.79, respectively; p=0.02) post-intervention. Moreover, the ulcer risk for poor outcomes, based on the SINBAD score, reduced significantly only in the study group, compared to the baseline (p=0.041). The control group showed non-significant changes compared to the baseline in all outcome measures (p>0.05). CONCLUSION: From the findings of this RCT, Buerger-Allen exercise, in combination with standard wound care, may help accelerate the healing of neuropathic DFUs in patients with type 2 diabetes, and could be suggested as part of the management plan for such conditions as an easy-to-perform offloading exercise intervention.

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

BACKGROUND: The latest demographics, clinical and living conditions, and comorbidities of patients with thromboangiitis obliterans (TAO) in Japan are unknown.Methods and Results: We conducted a retrospective cross-sectional survey using the annual database of the Japanese Ministry of Health, Labour and Welfare medical support system for patients with TAO between April 2013 and March 2014. This study included 3,220 patients (87.6% male), with current age ≥60 years in 2,155 patients (66.9%), including 306 (9.5%) patients aged ≥80 years. Overall, 546 (17.0%) had undergone extremity amputation. The median interval from onset to amputation was 3 years. Compared with never smokers (n=400), 2,715 patients with a smoking history had a higher amputation rate (17.7% vs. 13.0%, P=0.02, odds ratio [OR]=1.437, 95% confidence interval [CI]=1.058-1.953). A lower proportion of workers and students was seen among patients after amputation than among amputation-free patients (37.9% vs. 53.0%, P<0.0001, OR=0.542, 95% CI=0.449-0.654). Comorbidities, including arteriosclerosis-related diseases, were found even in patients in their 20-30 s. CONCLUSIONS: This large survey confirmed that TAO is not a life-threatening but an extremity-threatening disease that threatens patients' professional lives. Smoking history worsens patients' condition and extremity prognosis. Long-term total health support is required, including care of extremities and arteriosclerosis-related diseases, social life support, and smoking cessation.

Knowledge Mapping of Global Status and Trends for Thromboangiitis Obliterans: A Bibliometrics and Visual Analysis.

Objective: Thromboangiitis obliterans (TAO) is a segmental nonatherosclerotic inflammatory vascular disease characterized by recurrent progressive inflammatory reactions and thrombosis in the small and medium-sized arteries and veins of the extremities. However, there are few bibliometric studies on TAO. Therefore, this study was employed to generalize the research status, hotspots and development trends of TAO-related research. Methods: The data from 1999 to 2022 were collected from the Web of Science core collection database, and analyzed through bibliometrics software. VOSviewer was utilized to carry out academic collaboration between different countries/regions, institutions, and authors, visualization map of co-cited authors, journals, reference, and co-occurring keywords. CiteSpace was used to analyze the dual-map of journals, keyword bursts, and timeline of keywords. Bar and pie charts in this study were statistically analyzed and graphed through Microsoft Excel 2021. Scimago Graphica was applied to map the academic collaboration between different countries/regions. Results: A total of 553 literatures were involved in this study. Japan at the leading global position not only in the number of publications, but also total citations, average citations and H-index. Institution with the major contribution to TAO research is Mashhad University of Medical Sciences, and Nagoya University. Annals of Vascular Surgery, Angiology, Journal of Vascular Surgery are the main publication channel for articles related to TAO. Fazeli, B., Iwai, T., and Kihara, Y. are major contributors in this field. The studies on TAO keywords could be grouped into four clusters: Etiology, Mechanism, Cell therapy and Clinical therapy. Conclusion: Although the number of TAO publications has fluctuated over the past 20 years, it has generally shown a steady upward trend. Etiology and treatment research on TAO and some keywords such as trail, therapy, outcome, management, stem cells, angioplasty, and activation will become a hot spot in the future.

Top 100 cited articles in the thromboangiitis obliterans: a bibliometric analysis and visualized study.

OBJECTIVE: Thromboangiitis obliterans (TAO) is one of the most common types of peripheral arterial disease (PAD). This study aimed to explore the characteristics of the top 100 most cited articles in the TAO. METHODS: A bibliometric analysis based on the Web of Science (WOS) database was performed. Literature was retrieved and ranked by the citations. Listed below are the top 100 citations, including original articles, reviews, full-length proceeding papers, and case reports that were included for analysis. The type of literature, research areas, and languages were recorded. The trends of citations including the total citations, an analysis of publication and citation numbers were conducted each year. We analyzed citations from highly cited countries, authors, institutions, and journals. Research hotspots were gathered by a visualized analysis of author keywords. RESULTS: Most of the highly cited literature was original articles. A rising trend was observed in the number of citations per year. The peaks in the number of highly cited articles appeared in the year 1998 and 2006. The majority of the articles focused on the cardiovascular system and surgery. Journal of Vascular Surgery published most of the highly cited articles. The USA and Japan contributed nearly half the number of highly cited articles. Mayo Clinic and Nagoya University were highly cited institutions. Shionoya S and Olin JW were both the author with the largest number of citations and the most highly cited author in the reference. Articles that were highly cited most often addressed the following topics: "vasculitis", "autoimmune disease", and "critical limb ischemia". Keywords that were mostly used in recent years were "stem cell therapy", "progenitor therapy", and "immunoadsorption". The detection of bursts of author keywords showed the following: "permeability", "differentiation", and "critical limb ischemia" are recent keywords that have burst. CONCLUSIONS: In this study, the highly cited contributors in the field of TAO research were identified. Most cited articles in the top 100 focused on the cardiovascular system and surgery. Treatment and pathophysiology including stem cell therapy, progenitor therapy, genetics, autoimmunity, and inflammation are the hotspots of TAO.

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

Herein, we report a case of intermittent claudication (IC) caused by Buerger's disease (thromboangiitis obliterans {TAO}), which we treated using supervised exercise therapy (SET). The patient was a 58-year-old male with a history of smoking who presented with IC and resting pain in the right lower extremity, which had led to necrosis of the right first toe eight years prior to presentation. The non-healing right first toe was amputated and the patient underwent angiogenesis therapy in the right lower extremity. Despite continued strict smoking cessation and antiplatelet medication, the patient presented with IC of the left lower extremity eight years after the previous symptoms. Therefore, the patient underwent SET once a week (40 min per session) for five months, resulting in a total of 21 sessions. Consequently, the patient's walking ability and quality of life (QoL) significantly improved. These results suggest that SET is an effective treatment for TAO-induced IC. However, further studies are required to demonstrate its efficacy.

Successful lumbal sympathetic block as an alternative therapy for improving Buerger's disease: A rare case report and literature review.

INTRODUCTION AND IMPORTANCE: Buerger's disease is an inflammation of blood vessels that is strongly related to smoking habits. Lumbal sympathetic block is one kind of lumbal sympathectomy intervention that is used to manage chronic pain, including Buerger's disease. In this case report, we present the case of a Buerger's disease patient treated with a lumbal sympathetic block procedure. CASE PRESENTATION: A 63-year-old male was referred to our emergency room with chronic pain and ulcers on his left foot. He had already undergone two debridement procedures at his previous hospital without any improvement. After a comprehensive assessment, our cardio-thoracic specialist chose to refer the patient to undergo the lumbal sympathetic block with the orthopaedic specialist. After two procedures, we found a reduction in pain (VAS 6-7 to 2-3), the skin looked more colored, and the patient's walking distance improved from 10 to 100 m without any complaints. We also found good wound healing of the ulcers in his left foot; they became smaller and dryer. CLINICAL DISCUSSION: Lumbal sympathetic block is thought to be able to reduce peripheral retention that causes the opening of an arteriovenous anastomose, thus increasing blood flow to skin tissue and leading to vasodilatation. It showed its capability to prevent Buerger's disease progression, reduce patient complaints, and heal the wound. CONCLUSION: Lumbal sympathetic block should be considered as an alternative therapy for Buerger's disease.