Which clinical sign is most directly explained by reduced tissue perfusion due to advanced atherosclerotic narrowing in peripheral arteries?

• A. Frequent epistaxis (nosebleeds) because atherosclerotic narrowing increases nasal mucosa perfusion.
• B. Increased hair growth on the legs due to improved perfusion from narrowed arteries.
• C. Sudden improvement in exercise tolerance because plaques act as metabolic boosters for muscles.
• D. Intermittent claudication (exercise‑induced calf pain) because reduced arterial lumen limits blood flow during increased demand.

Answer: (D)