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intermittent claudication

Practice targeted AMC-style multiple-choice questions on intermittent claudication.

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A 68-year-old man with a history of smoking and hypertension presents with intermittent claudication in his right leg. Ankle-brachial index (ABI) is 0.6 on the right and 0.9 on the left. He has been on a supervised exercise program and optimal medical therapy for 6 months with no improvement in symptoms. What is the most appropriate next step in management?

A. Continue with the current exercise program and medical therapy
B. Consideration for revascularization with angioplasty or bypass surgery
C. Start a trial of cilostazol
D. Increase the dose of his antihypertensive medication
E. Refer for a vascular ultrasound to reassess the ABI
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