A 46-year-old man with diabetes mellitus, ongoing tobacco use, hypertension, and hyperlipidemia…

A 46-year-old man with diabetes mellitus, ongoing tobacco use, hypertension, and hyperlipidemia complains of 2-block claudication in both legs. His symptoms improve with standing and are consistent from day to day. He has no rest pain or ulceration. His symptoms have been stable for the past 2 years. His blood pressure is 150/70 mm Hg with a regular pulse of 80 beats per minute. His chest is clear on auscultation. His carotid upstrokes are normal without bruit. Cardiac examination identifi es a normal jugular venous pressure and apical impulse. Findings on auscultation are normal. He has normal pulses in the femoral and popliteal arteries bilaterally without bruit. Th e pedal pulses are not palpable. His extremities do not have ulcers, ischemic fi ssures, dependent rubor, or elevation pallor. Th e ankle-brachial index is 0.55 on the right and 0.52 on the left . An angiogram performed at his local medical facility 1 year ago showed severe infrapopliteal arterial occlusive disease with diseased but patent proximal arteries bilaterally. What is the most appropriate treatment regimen for this patient with intermittent claudication? a. Computed tomographic angiography (CTA) of the legs b. Magnetic resonance angiography (MRA) of the legs c. Risk factor modifi cation and the Canadian walking program d. Angioplasty and stenting e. Bypass surgery

 

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