A Man With Leg Pain

A 68-year-old man presents to the clinic with pain in the left calf that starts after walking two blocks on the way to his neighborhood grocery store. After 5-10 minutes of rest, he feels relief and can walk another block to the store. His medical history is positive for type 2 diabetes mellitus (T2DM), hypertension (HTN), and chronic kidney disease (CKD). His medications include an angiotensin-receptor blocker, calcium channel blocker, simvastatin, and sodium-glucose cotransporter-2 inhibitor.

His blood pressure is 136/85 mm Hg, heart rate is 76 bpm, and oxygen saturation on room air is 95%. Complete blood count values are within the reference ranges, creatinine level is 1.2 mg/dL, hemoglobin A1c concentration is 7.3%, and low-density lipoprotein level is 74 mg/dL. An ankle-brachial index is performed, which reveals values of 0.68 on the left leg and 0.89 on the right.

Aspirin is added to his medications and simvastatin is replaced with rosuvastatin.

Which one of the following interventions is likely to provide the greatest benefit to improving function with the least risk and adverse effects for this patient?

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