A 64-year-old man comes to the clinic complaining of a reproducible cramping pain in his right calf that occurs after walking approximately two blocks. The pain is consistently relieved by 5 minutes of rest. He has a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia. He has smoked a pack of cigarettes daily for the past 35 years. His temperature is 37.0°C (98.6°F), blood pressure is 142/88 mm Hg, and pulse is 76/min. Physical examination of the lower extremities reveals diminished dorsalis pedis and posterior tibial pulses on the right side compared to the left. The skin on the right shin appears shiny and hairless. Which of the following is the most appropriate next step in management?
- Measurement of the ankle-brachial indexAnswer
- BComputed tomography angiography of the lower extremities
- CVenous duplex ultrasonography
- DMeasurement of serum D-dimer levels
- ERecommendation for a supervised walking program
Answer
Measurement of the ankle-brachial index
The patient's presentation of reproducible calf pain relieved by rest in the setting of cardiovascular risk factors (heavy smoking, diabetes, hypertension) is classic for intermittent claudication due to peripheral arterial disease (PAD). The most appropriate initial noninvasive diagnostic test for suspected PAD is the measurement of the ankle-brachial index (ABI), which compares the systolic blood pressure measured at the ankle to the systolic blood pressure measured at the brachial artery.
Step-by-Step Solution
Key Concept
The initial diagnosis of Peripheral Arterial Disease (PAD) is established using the ankle-brachial index (ABI).
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