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Hello, Nancy,Welcome to Just Answer and thanks for your question. Sorry to hear about your brother's problems. Buerger's disease (thromboangiitis obliterans) is a fairly rare autoimmune disease of the arteries and veins that seems to be triggered by some component in tobacco. The blood vessels become inflamed and can form thrombi (clots) that interfere with circulation, resulting in lesions (sores). It is strongly associated with cigarette smoking, and the very first treatment to prevent progression of the disease is to stop smoking completely. It is really the only treatment to stop the disease. Other treatments such as antibiotics to treat infections, pain medications, and amputation of affected body parts are possible. Some clinicians have experimented with anticoagulant therapy (coumadin, Plavix) with only the mildest improvement in symptoms. The only definitive treatment is absolute and complete avoidance of tobacco in any form. Any large hospital with a rheumatology department anywhere in the USA can treat him.