Diagnosing Peripheral Arterial Disease and Confirmatory Tests Case Study

A 65-year-old man. heavy cigarette smoker presents with the chief complaint of leg pain. He noticed bilateral buttocks and thighs ache when he walks more than few blocks, the pain resolves with rest. He denies any history of trauma or problems with his joints. His past medical history is significant for myocardial infarction (MI) at the age of 61 years when questioned, he had impotence beginning a few months prior to his MI. On physical examination, his heart and lung examination were within normal limits. His radial pulses are intact and equal but his femoral and dorsalis pedis pulses are diminished bilaterally. The skin of the legs is cool to touch and appears shiny with very little hair growth. There is no swelling or erythema of his hip or knee joints.

1. What is the most likely diagnosis?

2. What tests and/or imaging tools could be used to confirm the diagnosis?

3. What risk factors are associated with an increased incidence of this condition?

4. What is the most appropriate treatment for this patient?

5. What are the treatment options for patients who fail conservative therapy?