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Peripheral artery disease with claudication — ABIM Board MCQ

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HardCardiovascularPeripheral artery disease with claudicationABIM Board

A 70-year-old man with type 2 diabetes and a 40-pack-year smoking history reports reproducible bilateral calf pain after walking two blocks. The pain resolves within several minutes of rest. He stopped smoking 3 years ago. Dorsalis pedis pulses are diminished bilaterally, and the resting ankle-brachial index is 0.62. He has no ischemic rest pain, nonhealing wounds, or gangrene and has not received structured exercise or pharmacologic therapy for peripheral artery disease. His LDL cholesterol is 126 mg/dL. Which initial management strategy best addresses both his walking impairment and cardiovascular risk?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Supervised exercise therapy, single antiplatelet therapy, and high-intensity statin therapy

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · B = shown as D · C = shown as E

The patient has stable intermittent claudication due to chronic symptomatic peripheral artery disease. Initial treatment should combine supervised exercise therapy to improve walking performance with cardiovascular risk reduction using single antiplatelet therapy and a high-intensity statin. Continued tobacco abstinence and diabetes management are also essential. Unstructured walking advice alone (A) is less effective than a structured program. Revascularization and anatomic imaging (B) are considered when functionally limiting symptoms persist despite guideline-directed medical therapy and structured exercise, or when limb-threatening ischemia is present. Cilostazol can improve walking distance but is an adjunct and does not replace antiplatelet therapy (C). Full-intensity warfarin (E) should not be used for PAD in the absence of another indication, such as atrial fibrillation or venous thromboembolism.

Reference: Gornik HL, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease, sections on antiplatelet therapy, lipid lowering, exercise, and revascularization. 2024. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2024/05/09/15/00/2024-guideline-for-lower-extremity-pad