A 52-year-old man comes to the physician for routine health maintenance examination. BMI is 35. Vitals are normal. Physical examination shows 3+ pulses in the upper and lower extremities. Current medications are lisinopril and metformin. He has smoked one pack of cigarettes daily for the past 20 years.
Which of the following is the next best step in diagnosis?
Ankle-brachial indices
Chest x-ray
Electromyography and nerve conduction studies
Fungal culture
Ultrasound
