Calf Pain, Smoking History and Weak Pulses

🗒️ Question

A 66 year old man presents with cramping pain in his calves when walking that resolves after a few minutes of rest. He reports the pain has gradually worsened and he is now able to walk only 50 metres before needing to stop. He has a history of smoking and hypertension.

On examination, his feet appear pale and there are weak dorsalis pedis pulses bilaterally.

Which of the following is the most likely diagnosis?

(A) Chronic venous insufficiency

(B) Peripheral arterial disease

(C) Diabetic neuropathy

(D) Spinal stenosis

(E) Deep vein thrombosis