DOI: https://doi.org/10.36347/sasjm.2026.v12i05.034

Pages: 557-562

A 50-year-old chronic smoker (40 pack-years) presented with a painful leg ulcer evolving for 2 months after scarification. Biopsy suggested pyoderma gangrenosum, and laboratory workup was unremarkable. However, arterial Doppler and angiography revealed total thrombosis of the subrenal abdominal aorta extending to the iliac arteries and bilateral deep vein thrombosis, consistent with Buerger’s disease. The patient underwent smoking cessation, double antiplatelet therapy, ACE inhibitors, and aortoiliac stenting. Despite intervention, necrosis progressed, and leg amputation was required. This case highlights the critical role of vascular imaging in evaluating leg ulcers and emphasizes smoking as a key factor in disease progression. Early recognition and intervention are essential for limb salvage and improved outcomes in Buerger’s disease.