Peripheral Artery Disease

A 61-year-old woman presents with a 3-year history of discomfort in the right thigh on exertion. Her symptoms have recently progressed to involve the right calf. She is able to walk no more than 50 m before having to stop because of leg pain. Her medical history is notable for coronary-artery bypass surgery after a myocardial infarction at 55 years of age and for hyperlipidemia, for which she takes atorvastatin at a dose of 40 mg daily. She has a smoking history of 50 pack-years and currently smokes eight cigarettes per day. On examination, the blood pressure is 126/82 mm Hg, there is a bruit over the right femoral artery, and pulses are diminished in the right leg. How would you evaluate and manage this case?