A 58-year-old man presents to the emergency room complaining of severe pain in his left foot that woke him from sleep. He has a history of chronic stable angina, hypercholesterolemia, and hypertension, for which he takes Aspirin, Atenolol, and Simvastatin. He has experienced pain in both calves and feet with walking for several years, and the pain has gradually progressed so that he can now only walk 100 feet before he has to stop because of pain. He occasionally has experienced mild pain in his feet at night, but the pain usually gets better when he sits up and hangs his feet off the bed.
This time, the pain was more severe and did not improve, and he now feels like the foot is numb and he cannot move his toes. On physical examination, he is afebrile, with a heart rate of 72 bpm and blood pressure 125/74 mm Hg. Head and neck examination are significant for a right carotid bruit. His…
