Peripheral artery disease and venous insufficiency share many symptoms but affect different types of blood vessels. Each has distinguishing symptoms, risk factors, and diagnostic markers.

Peripheral artery disease (PAD) and chronic venous insufficiency (CVI) are two common peripheral vascular diseases. Both conditions affect blood circulation in the lower body and may cause pain and skin-related symptoms.

One key difference is that PAD involves the arteries, while CVI involves the veins.

Arteries branch out from the heart to deliver oxygen-rich blood to the rest of the body. Veins transport deoxygenated blood back to the heart.

This article compares and contrasts both conditions, including their symptoms, causes, and diagnosis.

PAD and venous insufficiency both affect the lower extremities, including the legs and feet. They can cause similar symptoms.

People with PAD don’t always have symptoms. But one common symptom is leg pain during physical activity that goes away with rest. This is known as claudication.

In contrast, people more often describe leg pain from CVI as dull, aching, or throbbing. It’s less likely to occur with exercise and may improve if you sit with your legs elevated.

The table below outlines some other common lower extremity symptoms of PAD and CVI:

Leg and feet symptomsPADCVI
cold skin
dull, aching, or heavy legs
itchy skin
muscle cramps
numbness and tingling
skin discoloration
slowed hair and nail growth
ulcers and sores
varicose veins

Atherosclerosis most often causes PAD. Atherosclerosis is when plaque builds up and hardens in your arteries, making them narrow and rigid. This limits the flow of oxygenated blood to your legs and feet, leading to PAD symptoms.

CVI, on the other hand, is usually linked to varicose veins and blood clots. Varicose veins indicate that the valves in the veins are damaged and leaking, while clots in the leg veins can block blood flow.

In both cases, it’s difficult for blood in the lower limbs to return to the heart, which can trigger symptoms of venous insufficiency.

PAD and CVI are more likely to occur in older people. Other shared risk factors include:

According to the Centers for Disease Control and Prevention (CDC), PAD is more likely to affect Black adults and people who have:

CVI, on the other hand, is most common among females. Some other risk factors include:

The diagnostic process is similar for both PAD and CVI. A doctor starts by asking about your symptoms, medical history, and family history. Then, they conduct a physical examination.

If a doctor suspects PAD, they can usually use an ankle-brachial index test to make a diagnosis. This test compares blood pressure levels in your ankle versus your arm. Low blood pressure in the ankle compared with the arm can be a sign of PAD.

If your doctor suspects CVI, they might order an ultrasound. This noninvasive test helps your doctor visualize blood flow through the veins.

For mild to moderate cases of both PAD and venous insufficiency, doctors often recommend lifestyle strategies and medication. Sometimes, surgical procedures are required.

The following chart summarizes the main treatments for PAD and CVI:

Lifestyle strategiesnot smoking
• exercising regularly
• eating a heart-healthy diet
• managing coexisting health conditions
• wearing prescription compression socks
• exercising regularly
• keeping legs elevated
• avoiding long periods of standing or sitting
Medicationblood thinners
blood pressure medications
cholesterol medications
• diuretics
Proceduresperipheral angioplasty and stent placement
leg bypass surgery
• laser therapy
stent placement

PAD and CVI tend to worsen over time. If left untreated, both can lead to foot and leg ulcers that are difficult to heal. This complication increases your risk of infection. It can even lead to amputation.

Lifestyle strategies can help slow the progression of both conditions. If a doctor has diagnosed PAD or venous insufficiency, talk with them about what you can do to lower your risk of complications.

See below for some of the commonly asked questions about PAD and CVI.

How can you tell the difference between arterial and venous disease?

The symptoms of arterial and venous diseases can overlap. Your doctor will ask about your symptoms and order tests to determine whether the problem involves the veins or the arteries.

What can be mistaken for PAD?

When diagnosing PAD, a doctor asks about your symptoms and orders tests to rule out conditions that cause similar symptoms, such as venous insufficiency, deep vein thrombosis, or sciatica.

Can you have both PAD and venous insufficiency?

It’s possible to have both PAD and venous insufficiency. According to a 2020 study including 180 people with known or suspected PAD, approximately 21% also showed signs of CVI.

PAD and CVI are two types of peripheral vascular disease. PAD affects the arteries, while CVI affects the veins.

Both PAD and CVI affect blood circulation. Symptoms may include leg pain and skin changes. The main differences and similarities are summarized below:

Symptomsexercise-dependent leg paindull, aching, or throbbing leg pain
Common causesatherosclerosisblood clots, malfunctioning valves in leg veins
Risk factorsbeing older, Black, and/or having diabetesbeing older and/or female
Diagnostic testsankle-brachial indexultrasound
Treatmentslifestyle strategies, medication, and surgerylifestyle strategies, medication, and surgery
Outlooksymptoms usually worsen over time but treatment helpssymptoms usually worsen over time but treatment helps