[5] There are characteristic pathologic findings of acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet (the lower limbs being more common).

The mechanisms underlying Buerger's disease are still largely unknown, but smoking and tobacco consumption are major factors associated with it.

It has been suggested that the tobacco may trigger an immune response in susceptible persons or it may unmask a clotting defect, either of which could incite an inflammatory reaction of the vessel wall.

[citation needed] Some diseases with which Buerger's disease may be confused include atherosclerosis (build-up of cholesterol plaques in the arteries), endocarditis (an infection of the lining of the heart), other types of vasculitis, severe Raynaud's phenomenon associated with connective tissue disorders (e.g., lupus or scleroderma), clotting disorders or the production of clots in the blood.

[citation needed] Angiograms of the upper and lower extremities can be helpful in making the diagnosis of Buerger's disease.

[citation needed] In acute cases, drugs and procedures which cause vasodilation are effective in reducing pain experienced by patient.

[1] There is moderate certainty evidence that intravenous iloprost (prostacyclin analogue) is more effective than aspirin for relieving rest pain and healing ischemic ulcers.

[11] No difference have been detected between iloprost or clinprost (prostacyclin) and alprostadil (prostaglandin analogue) for relieving pain and healing ulcers.

There may be a benefit of using bone marrow-derived stem cells in healing ulcers and improving pain-free walking distance, but larger, high-quality trials are needed.

[16] It was not until 1908, however, that the disease was given its first accurate pathological description, by Leo Buerger at Mount Sinai Hospital in New York City, who referred to the condition as "presenile spontaneous gangrene".

[17] As reported by Alan Michie in God Save the Queen, published in 1952 (see pages 194 and following), King George VI was diagnosed with the disease on 12 November 1948.

On 12 March 1949, the king underwent a lumbar sympathectomy, performed at Buckingham Palace by James R. Learmonth.

The operation, as such, was successful, but the king was warned that it was a palliative, not a cure, and that there could be no assurance that the disease would not grow worse.