Introduction: Thromboangiitis obliterans (TAO), or Buerger’s disease, is an inflammatory vasculitis affecting small and medium-sized vessels, leading to ischemia, pain, and non-healing ulcers. In advanced cases, revascularization is often not feasible, making chemical sympathectomy a viable option for symptom relief and ulcer healing. This study evaluates the efficacy of CT-guided lumbar chemical sympathectomy in TAO patients with chronic lower limb pain and non-healing ulcers. Methods: This retrospective study included 28 TAO patients who underwent CT-guided lumbar sympathectomy from Aug 2017 to Jan 2024 at a tertiary care center. Primary outcomes noted were changes in claudication distance, Ankle-Brachial Pressure Index (ABPI), and Pressure Ulcer Scale for Healing (PUSH) scores assessed at 1 week, 2 months, and 6 months post-procedure. Results: Significant improvements were observed in initial and absolute claudication distance (ICD: 45.86m to 145.93m, ACD: 111.96m to 211.14m at 6 months, p<0.001). ABPI increased from 0.61 to 0.91 (p<0.001) indicating improved blood flow. Among 21 patients with ulcers, 28.6% achieved complete healing, while the remaining showed substantial improvement. Conclusion: CT-guided lumbar sympathectomy is an effective intervention for pain relief and ulcer healing in TAO patients, significantly improving the outcomes. It offers a valuable alternative for patients ineligible for revascularization, reducing the risk of amputation and enhancing quality of life.