Lower Limb Hypoperfusion

A 67-year-old man presents to the clinic complaining of progressive pain and swelling behind his right knee that started one month ago. The pain caused him to quit his weekly golf lessons. This morning he felt his foot was "cooler than usual" and the pain was severe enough to force him to visit the clinic. The patient has a history of hypertension, diabetes mellitus and he is also a heavy smoker. He has been a former construction worker for 45 years and retired 2 years ago. Although his vitals are normal, physical examination reveals a palpable mass in the right popliteal fossa. His right lower limb is also cold with diminished distal pulses. The rest of the physical examination is unrevealing. The patient remains in the hospital for further evaluation.

Which is the pathophysiologic mechanism of the disease causing this patient's symptoms?

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