Poor Circulation? How to Know If You Have Peripheral Artery Disease (PAD) or Chronic Venous Insufficiency
Key takeaways:
Peripheral artery disease (PAD) and chronic venous insufficiency (CVI) are conditions that typically affect the blood vessels in your legs.
PAD is a disease of the arteries — the blood vessels that take oxygenated blood to the tissues.
CVI is a problem with the veins — the blood vessels that take deoxygenated blood from the tissues back toward the heart.
People with PAD may feel pain in their legs, while people with CVI tend to get leg swelling and varicose veins.
Table of contents
People often confuse peripheral arterial disease (PAD) and chronic venous insufficiency (CVI). That’s because they’re both vascular (blood vessel) problems that affect peripheral structures in the body, typically your legs and feet. While PAD and CVI both cause issues with blood circulation, their symptoms and treatments are different. At the same time, both conditions share some common risk factors, which means it’s possible to have both.
Here’s what you need to know about vascular diseases of the legs — and how to tell if your symptoms are from PAD, CVI, or both.
Peripheral artery disease vs. chronic venous insufficiency
The first step to understanding the differences between PAD and CVI is learning what the arteries and veins do.
Arteries are blood vessels that carry oxygen-rich blood from your heart to all of the organs and tissues in your body. Because they carry high-pressure blood pumped out of your heart, arteries have thick, muscular walls.
Veins are blood vessels that take deoxygenated blood back toward your heart from organs and tissues around your body. Venous blood moves at low pressure and has to work against gravity to get back to your heart. Veins have some special features that help them move venous blood along:
Their walls are thin and floppy.
They have a system of valves that keep blood from flowing backward.
Muscles surrounding the veins, like the ones in your legs, squeeze the veins to keep venous blood moving along.
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What is peripheral arterial disease?
Like its name suggests, PAD is a problem that affects your arteries. It affects the supply of oxygen-rich blood to different parts of your body. PAD commonly affects the legs, but it can also involve vital organs (like your kidneys, gut, and brain).
What is chronic venous insufficiency?
CVI is a problem that affects the veins. It affects how blood flows back to your heart. Instead of moving easily upward, blood can pool in your legs because of gravity.
Symptoms of PAD vs. CVI
People in the beginning stages of PAD or CVI might not have any symptoms. But when symptoms do develop, they’re usually very different. That’s why paying attention to specific symptoms can help you tell the difference between PAD and CVI.
Below is a comparison of the common symptoms of PAD and CVI.
PAD symptoms | CVI symptoms |
Tiredness, aching, or cramping in your legs, especially while walking (claudication) | Dull pain or a tight, tired feeling in your legs |
Cold lower legs and feet | Warm feeling in your legs, with varicose or spider veins |
Loss of leg hair and slow toenail growth | Leg swelling (edema), especially after standing for long periods of time |
Bluish or pale skin | Dark, leathery skin |
Ulcers on your toes and feet | Ulcers on your legs, especially near your ankles |
Causes and risk factors for PAD and CVI
PAD and CVI both often affect your lower extremities. But their causes are quite different.
Causes
PAD is a narrowing or blockage of the arteries that carry blood to your organs and tissues. This is usually caused by cholesterol deposits (atherosclerosis) that form in your arteries. It’s a similar process to what happens in your heart arteries to cause a heart attack.
CVI usually happens when the veins are damaged in some way. This damage can come from a blood clot, an injury, or from sitting or standing for long periods of time.
Risk factors
PAD and CVI share some common risk factors. You’re more likely to have blood vessel issues if you:
Have a family history of blood vessel problems
Are over 50 years of age
Have a BMI greater than 30
But some risk factors are unique to each condition.
PAD is more common in people who have a history of:
CVI is more common in people who:
Have a history of a deep venous thrombosis (leg blood clot), or previous leg injury or surgery
Have a family history of CVI
Have a higher body weight
Are pregnant
Are female
Smoke
Stand for long periods of time or don’t get enough exercise
If any of these risk factors apply to you, it’s important that you discuss them with your primary care provider. This promotes early detection of PAD and CVI. Many of these same risk factors are also common risk factors for conditions like heart attack or stroke.
Diagnoses for PAD and CVI
If you think you could have PAD or CVI, the first step is to speak to a healthcare professional. They’ll ask you about your medical and surgical history and any family history of blood vessel problems. They’ll also want a detailed description of your symptoms.
You’ll need to take off your shoes and socks so your primary care provider can do a physical examination. They will:
Look closely at your legs and feet for skin discoloration, ulcers, and swelling
Check for temperature differences between your legs and feet
Feel for pulses (impulses in your arteries when your heart beats) in your legs and feet
If anything seems unusual during your examination, you may need additional tests.
Tests for PAD
If your healthcare professional thinks you may have PAD, they might order some of the following tests to help with diagnosis:
Ankle-brachial index (ABI): This is a measurement that compares blood pressure in your arms and legs to check for a drop-off between the two.
Ultrasound: This test uses sound waves to look at the blood flow in blood vessels and detect blockages.
Angiography: This test uses contrast dye and imaging (like CT or MRI scans) to help find any blockages. A vascular specialist can also do an angiography procedure with X-rays and then treat any blockages at the same time.
Tests for CVI
A common test to look for CVI uses a special ultrasound scan. This test looks at the veins in your legs to see how well blood moves through them.
Sometimes, you may need additional tests like a CT scan or MRI to find out why your veins aren’t draining blood properly back to your heart.
Treatments for PAD and CVI
PAD and CVI are different problems that affect different types of blood vessels. Because of that, their treatments are also different. Treatments for PAD help bring more blood flow to your legs and feet. Treatments for CVI focus on bringing blood from your legs back to your heart.
PAD treatments
Treatment for PAD typically centers on improving symptoms and preventing PAD from getting worse.
There are behavior and lifestyle changes you can make, including:
Quitting smoking
Treating medical conditions that increase your risk of PAD, like diabetes, high cholesterol, and high blood pressure
Starting a prescribed, structured walking program to help improve the blood flow in your legs
Medical treatments for PAD include:
Medications: Some medications, like cilostazol and pentoxifylline, can help with symptoms.
Angioplasty: This is a procedure to open the blockage and improve blood flow through your artery. With the visual help of an X-ray, a specialist inflates a small balloon to open your artery. Sometimes, a wire-mesh scaffold (a stent) is placed to keep it open.
Surgery: A surgeon can “bypass” a diseased artery to redirect blood flow around the narrowing or blockage.
CVI treatments
To decrease swelling and discomfort — and keep CVI from getting worse — there are several things to try before considering medications or procedures.
If you have CVI, try the following:
Avoid standing for prolonged periods of time.
Elevate your legs whenever you can.
Wear compression stockings.
Stay active to help your leg muscles move blood back to your heart
If these measures aren’t enough, you may need:
Wound care: It’s important to take good care of your skin. This helps prevent skin breakdown and infection. If you get an infection, you may need antibiotics.
Minimally invasive procedures: Options like endovenous ablation or sclerotherapy close off damaged or problematic veins to improve overall blood flow.
Surgery: Although rare, if needed, a surgeon can tie off or remove a damaged vein so blood can flow through healthier ones.
How to prevent blood vessel disease in your legs
You can take steps to prevent PAD and CVI by:
Getting more exercise
Keeping your weight in a range that is healthy for you
Making nutritious food choices
Staying on top of treatment for other medical conditions — like diabetes, high cholesterol, and high blood pressure.
It’s always a good idea to visit your healthcare team regularly. They can help you stay on the right track with ways to prevent vascular disease and improve your overall health.
When to consult a doctor
If you’re having new symptoms in your legs, arms, or feet, consider getting medical attention. Signs to watch out for include:
Changes in color or temperature
Swelling that gets worse
Worsening pain or discomfort
A healthcare professional can help determine what’s going on, and recommend any testing if necessary.
Frequently asked questions
“Leaky veins” isn’t a medical term, but people usually use it to describe venous insufficiency.
Damage to a vein or vein valves can’t be reversed. But by following the prevention tips and treatments mentioned above, you can slow down the progression of venous insufficiency.
The bottom line
When people say they have poor circulation, they could have peripheral artery disease (PAD) or chronic venous insufficiency (CVI). These are both blood vessel conditions that affect circulation — usually in your legs. While PAD and CVI share several of the same risk factors, they’re different problems that affect different types of blood vessels. Because of that, the symptoms, tests, and treatments for PAD and CVI are quite different.
If you’re having new or unusual symptoms in your legs — like pain or swelling — it’s best to check in with your healthcare team. They can help find out if the problem is with your arteries or veins. You can lower your risk for both PAD and PVD by quitting smoking, getting regular exercise, maintaining a comfortable weight, and eating a healthy diet.
Why trust our experts?
References
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