The natural course of life and limb is favorable in many patients with Buerger disease. Occurrence or recurrence of necrotic lesions usually is arrested in patients older than 60 years. To avoid factors that markedly influence quality of life, early treatment and strict instruction to prohibit smoking are mandatory. Arterial reconstruction shortens the healing process of ischemic ulcers, despite poor long-term results. However, bypass surgery to treat intermittent claudication should be limited.