A 65-year-old man presents with lower back pain and bilateral leg pain that worsens with walking and improves with rest. He also reports a history of smoking and high cholesterol. What are the possible causes and next steps?
This patient's symptoms suggest vascular claudication due to peripheral arterial disease, which is supported by his history of smoking and high cholesterol. Another possibility is spinal stenosis, which can also cause claudication symptoms. The next steps would involve a thorough vascular examination, ABI (ankle-brachial index) measurement, and imaging studies including lumbar spine MRI and potentially lower extremity arterial Doppler ultrasound or angiography.