A 38-year-old male smoker with gangrenous changes in the toes of both feet has an arteriogram showing normal vessels to the popliteal trifurcation and multiple occlusions distally in small vessels. The following is/are true:

a. Hyperlipidemia, diabetes, and autoimmune disease must be ruled out to make the diagnosis of Buerger’s disease

b. Plethysmographic evidence of digital obstruction in all four extremities with normal proximal vessels is sufficient evidence for Buerger’s disease without arteriography

d. In contrast to the lower extremities, Buerger’s involvement of the upper extremities rarely leads to amputations

Buerger’s disease is a panarteritis associated with intraluminal thrombus in young male smokers. Diabetes, hyperlipidemia and autoimmune diseases must be ruled out to fulfill the diagnostic criteria, but the diagnosis can be made plethysmographically by evidence of small vessel obstruction in all four extremities. Cessation of all tobacco use is the most important treatment. Management is conservative with only rare limb loss in the upper extremities as opposed to the lower.