Erectile Dysfunction in a Patient with Claudication

A 67-year-old male presents to his primary health care physician complaining about erectile dysfunction for the last 3 months. He states that he has normal sex drive, but he cannot remember the last time he had a nocturnal erection. His medical history includes dyslipidemia, hypertension, and stable angina. He takes aspirin, irbesartan-hydrochlorothiazide and atorvastatin. He is a current smoker with a 45 pack-year smoking history. Physical examination reveals weak groin and ankle pulses bilaterally. After further questioning, the patient admits having bilateral leg pain after walking barely approximately 100 feet. The pain is relieved upon rest. Urological examination is normal and cremasteric reflex is elicited.

What is the best next step in the evaluation of this patient's erectile dysfunction?

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