Reference no: EM133948714

Question

A 65-year-old man was sent from the clinic for worsening of left calf severe pain and decrease in exercise tolerance due to left calf pain. The patient had a 3-month history of intermittent left calf pain and denied trauma, back pain, fever, and leg weakness. Otherwise, the medical history was significant for hyperlipidemia. He was a former smoker and stopped smoking 6 months ago; however, he smoked 1 pack of cigarettes per day for the past 40 years before quitting.

On physical examination, vital signs were within normal ranges. Femoral pulses were diminished bilaterally. Popliteal, right dorsalis pedis, and right posterior tibialis pulses were faint. The left dorsalis pedis and posterior tibialis pulses were not palpable. Cardiac examination was normal. Otherwise, the physical examination was unremarkable.

The patient currently takes atorvastatin, daily low-dose aspirin and participates in an exercise program.

Case Review

This scenario represents a patient with progressive peripheral arterial disease (PAD) despite being on initial medical management. The signs of progressive PAD include progressive decrease in exercise tolerance due to worsening left leg pain and physical examination findings of nonpalpable dorsalis pedis and posterior tibialis pulse on the left side. The patient is already on initial medical management of PAD, including smoking cessation, aspirin, high-intensity statins, and a supervised exercise program.

1. What measures is the patient already doing to treat his PAD?

2. What other assessment data do you want to obtain?

3. How will you help the patient manage his pain?

4. What other measures might the healthcare provider begin?

5. What surgical procedures would be possibly suggested?