[Expert Solution]: Matthew Helm, 67 years of age, is a male…

Matthew Helm, 67 years of age, is a male patient who is admitted with the diagnosis of peripheral arterial occlusive disease in the right femoral and popliteal arteries. The patient undergoes a right femoral-to-popliteal graft operation. Preoperatively, the patient presented with the following assessment: the right leg skin is taut and shiny; very little hair is present; and the toenails are thick and opaque. The leg has pallor when lying on the bed flat, but when the patient places the leg over the side of the bed it has rubor and the toes are bluish in coloration. The patient states the pain in his leg as a constant excruciating pain that he rates as an 8 on the pain scale. No pedal or posterior tibial pulses are detectable with Doppler in the right leg and the popliteal artery is diminished and the femoral pulse is also diminished. The left leg is also shiny, taut, and has very little hair present and the nails are thick and opaque. The patient develops rubor when the leg is held over the side of the bed. The pulses are palpable and slightly diminished at all sites in the left leg. The patient has smoked one pack of cigarettes per day for 50 years. He presents with the following vital signs: BP, 160/110 mm Hg; pulse, 88; respiration, 22; and temperature, 98°F. He does not take any medications currently.