History:

A heavy-smoker man smoking more than two packs per day for more than 15 years suffered unilateral severe left foot pain after exercise for 6 months and one year later even at rest. Few months later ,an ulcer at the tip of the left big toe started to develop which increased in size gradually. On examination,a rounded ulcer having punched-out regular border with ischemic base was seen. Dorsalis pedis artery pulsation was negative on the affected side.Patient's history was negative for diabetes mellitus, autoimmune diseases, thrombotic or embolic disorders. Angiography result eas consistent with thromboangiitis oblitrans (Buerger's disease).