Peripheral Artery Disease vs. Peripheral Venous Disease

Medically Reviewed by James Beckerman, MD, FACC on February 14, 2024
4 min read

Peripheral artery disease (PAD) and peripheral venous disease (PVD) have a lot in common. Both are conditions that involve the vascular (or circulatory) system and affect the blood vessels in areas outside your heart. That means they are both types of peripheral vascular disease.

Blood vessels -- arteries and veins -- are tube-like structures that allow blood, oxygen, and waste to travel through your body. When arteries don’t work properly, your feet and legs can’t get enough oxygen and other needed supplies, like nutrients. And when veins aren’t working, there can be a buildup of blood materials, like fluid, in your limbs.

The two diseases differ in several key ways. PAD means you have narrowed or blocked arteries -- the vessels that carry oxygen-rich blood as it moves away from your heart to other parts of your body. PVD, on the other hand, refers to problems with veins -- the vessels that bring your blood back to your heart.

Most often PAD happens because of atherosclerosis, when plaque, cholesterol, and other substances build up within an artery’s wall and make it narrower inside. If enough plaque builds up, it can block blood flow inside the artery. (Blood clots can also get in the way of the flow.) Like PVD , there also seems to be a genetic component to PAD.

When the blood is blocked it lowers the amount of oxygen and nutrients that get to your limbs. This can create lasting damage to your skin, nerves, and muscle tissue. Less-common causes of PAD include injuries to the arteries, unusually shaped muscles or ligaments, and infections.

PVD has several different forms. With chronic venous insufficiency, the valves in your veins allow blood to flow backwards in the wrong direction. This can create pressure and strain that damage the tissues causing bulging of your veins, especially if you are pregnant, overweight, or tend to sit or stand in one position for a long time.

On the milder end, this condition can lead to spider veins -- small, raised, swollen blood vessels that twist and turn. As the problem becomes more severe, it can become painful and lead to varicose veins, which are larger but not life-threatening.

Half of people with PAD don’t have symptoms. Those who do often feel cramping in one or both of their lower legs when they are active but not when they rest. This is called intermittent claudication. In the most severe form of PAD, called critical limb-threatening ischemia, the blood supply is so low the limbs begin to show visible damage. Other PAD symptoms can include:

  • Legs that feel numb, weak, or heavy
  • Pain in specific areas at certain times (for example, at night)
  • Changes in the skin color or temperature, hair loss, or wounds that don’t heal
  • A weak pulse
  • Dead tissue (gangrene ) can be small, damaged veins appearing on the legs or feet, called spider veins. With more severe disease, veins can appear twisted and large (varicose veins). These visible changes can come along with uncomfortable symptoms in your legs including:
  • Feeling achy or heavy
  • Burning, throbbing, or muscle cramps
  • Swelling
  • Pain that gets worse if you’re in one position for a long time
  • Itching around your veins

If you have symptoms that make you suspect you have PAD or PVD, schedule a doctor visit and ask about them.

Tests to diagnose PAD include the ankle brachial index, which compares blood pressure levels in your ankles and your arms. Imaging tests like ultrasound and angiography can help health care providers take a look at what’s going on in your vascular system.

To diagnose PVD, doctors use Duplex ultrasound, an imaging test to look at your leg veins and blood flow.

PAD treatment can involve medications that prevent blood clots, like the antiplatelet drugs aspirin and clopidogrel. Your doctor may also prescribe other drugs to control high blood pressure and cholesterol. Exercise training and medications like cilostazol can improve walking capacity.

Healthy habits like getting more exercise and quitting smoking also can help.

Some people need a procedure called revascularization to open their arteries. Revascularization can be either a traditional surgery or a less-invasive procedure using a catheter. In very advanced PAD, doctors may need to amputate all or part of a leg.

PVD treatments include simple measures to ensure your blood keeps moving properly:

Other options include medicines to encourage blood flow. Your doctor may also recommend procedures such as laser or radiofrequency ablation, where heat from a catheter closes affected veins.

More severe PVD cases may benefit from sclerotherapy, in which an injected chemical causes scarring to close diseased veins, or surgery.

To prevent PAD and PVD, take care of yourself: get regular exercise, eat a healthy diet, and don’t smoke. It’s also important to take steps to control other conditions you may have like high blood pressure, high cholesterol, and diabetes. Ask your doctor about any symptoms you have. If you can catch the conditions early on, it’s possible to prevent milder forms from getting worse.