Introduction & Objective: Buerger's disease is a chronic inflammatory disease. It is strongly associated with smoking cigarets. Mostly young men (below 40-45 years old) are affected. Based on clinical experience, Iran has a high incidence of Buerger's disease. The aim of this study was to evaluate the clinical manifestations, the clinical course and therapeutic measures taken for these patients. Materials & Methods: In this retrospective study, we evaluated 3125 patients with peripheral arterial disease referred to Shohada Tsajrish Hospital during the last 20 years. The data of these patients were gathered through a direct questioning of the patients. Results: This study included 270 patients with Buerger's disease. The mean age of the patients was 42 years (26-75 years). The mean duration of smoking was 21±0.2 years. The most common clinical manifestations on admission included coldness of extremity (92.2%) color change of extremity (86.2%), necrotic ulcer (63.7%), rest pain (45.5%), intermittent claudication (44.07%) and gangrene (36.2%). Surgical measurements included vascular reconstruction by using saphenous vein (11.8%), sympathectomy (77.03%), and amputation (75.9%). Conclusions: Due to the nature of Buerger's disease that is an inflammatory, segmental and non-atherosclerotic disease and often affects the distal extremity, the vascular reconstruction is rarely possible. Therefore, most of these patients have to undergo sympathectomy and amputation.