The problem with the studies you received such as the MRI and CTA is they dont have the resolution to see smaller blood vessels. This would require a biopsy. Some medium and small vessel diseases respond to immune suppression with steroids etc, the treatment for Buergers is not smoking. Others such as livedoid vasculopathy (a vein disease) require anticoagulation.So again not vaping is essential to save your legs. Wouldnt recommend other nicotine containing products such as patch or gum, but bupropion and varenicline are effective smoking cessation aids.Personally if smoking cessation isnt effective and the symptoms progress I would want the biopsy despite the admittedly very high wound healing risk. There may be a proximal area with less advanced disease that is amenable, and your symptoms are end-stage.Can PM me if you have specific questions.
Did they ever do an angiogram while you were symptomatic? Or a mri or Ct with contrast while you had active symptoms?