A 70-year-old obese man, who had no hypertension and was not a smoker, complained of cramp-like pains in his legs during walking. He had noticed these symptoms a year earlier but they had become worse lately. The pain disappeared after he rested
The most likely cause of these symptoms is
A. atherosclerosis
B. syphilitic aortitis
C. aortic dissection
D. Buerger's disease
E. Raynaud's disease
A
This patient has intermittent claudication, which in the elderly most often is caused by atherosclerosis. Syphilitic aortitis involves the arch of the thoracic aorta. Aortic dissection is an acute event that does not manifest with peripheral ischemia but rather with massive bleeding through the dissected aortic wall. Buerger's disease is seen in smokers: once the symptoms of ischemia begin they do not remit. Raynaud's disease is caused by a spasm of smaller arteries and arterioles and involves peripheral parts of the extremities, causing symptoms such as paleness of the fingers and toes.
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