A 64-Year-Old Man Has Had Difficulty Walking for 6 Months

A 64-year-old man has had difficulty walking for 6 months, experiencing muscle cramps in his right thigh after walking a block on level ground.  The cramps subside quickly with rest.  He has also had decreased sexual performance.  Medical history is significant for hypercholesterolemia and myocardial infarction.  The patient smokes a pack of cigarettes daily but does not use alcohol or illicit drugs.  He is afebrile.  Blood pressure is 128/78 mm Hg, pulse is 76/min, and respirations are 16/min.  Cardiac auscultation reveals normal S1 and S2, and equal vesicular breath sounds are heard over the bilateral lungs.  The abdomen is soft and without masses.  There is no peripheral edema, muscle tenderness, or muscle weakness.  Which of the following is the most likely cause of this patient's symptoms?

A) Granulomatous inflammation of the arterial media
B) Homogenous acellular thickening of the arteriolar walls
C) Lipid-filled arterial intimal plaques
D) Medial band-like arterial calcification
E) Onion-like concentric thickening of the arteriolar walls

Correct Answer:

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