Peripheral Arterial Disease

A 68-year-old man with a 40-year smoking history presents with a 3-month history of progressive claudication in the right lower limb. Duplex ultrasound reveals a 70% stenosis of the right superficial femoral artery (SFA). He is asymptomatic at rest and can walk 200 meters before claudication. His ankle-brachial index (ABI) is 0.65 on the right. What is the most appropriate initial management?

A 68-year-old man with a 40-year smoking history and poorly controlled diabetes (HbA1c 9.2%) presents with a 3-month history of progressive pain in his right calf during walking that resolves after 10–15 minutes of rest. On examination, the right foot is cool to touch, femoral pulses are palpable bilaterally, but right popliteal and pedal pulses are absent. Ankle-brachial index (ABI) on the right is 0.62. Which of the following is the most appropriate next step in management?

A 72-year-old man with hypertension and hyperlipidemia presents with sudden onset of severe pain in the left leg, pallor, pulselessness, and coldness. On examination, the left foot is mottled and cyanotic; femoral pulse is absent on the left. Right femoral pulse is palpable. He denies recent trauma. Doppler ultrasound shows no flow in the left superficial femoral artery. What is the most likely diagnosis?

A 62-year-old man with diabetes and smoking history presents with claudication in the right lower limb for 3 months. On examination, the right femoral pulse is diminished and there is absence of dorsalis pedis pulse. What is the investigation of choice to confirm the diagnosis and determine the level of arterial stenosis?

A 65-year-old woman with critical limb ischemia (rest pain and a non-healing ulcer on the right foot) is deemed inoperable for revascularization due to diffuse disease. Medical optimization with aspirin and statin is ongoing. Which agent should be added to reduce amputation risk and improve symptoms?