Peripheral artery disease (PAD) is a type of peripheral vascular disease (PVD). PVD involves various blood vessels outside the brain and heart.

PAD refers to narrowed or blocked blood vessels that take oxygen-filled blood away from the heart, called arteries.

PVD refers to several diseases that affect the blood vessels, including a group of diseases known as chronic venous insufficiency.

One of these is PAD, a condition that develops when a waxy, fatty substance called plaque builds up on the walls of arteries and reduces the amount of blood that can flow through them in a process known as atherosclerosis.

Peripheral blood vessels feed the limbs and skin and do not directly connect to the heart.

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PVD and PAD symptoms differ, although both mainly occur in the legs. PAD may occasionally affect the upper limbs.

PVD

A type of PVD known as chronic venous insufficiency usually causes leg discomfort, tiredness, itching, and swelling early on. These symptoms might improve when a person lifts their leg or during rest. However, they are not linked to exercise, which is a crucial difference between PVD and PAD symptoms.

As the condition worsens, the following leg symptoms might develop:

  • spider veins, or telangiectases
  • varicose veins
  • reticular veins, which resemble smaller varicose veins
  • tenderness
  • pain
  • heaviness
  • aches
  • swelling that does not get better with treatment
  • skin changes, such as darkening skin

In the later stages, people with chronic venous insufficiency may develop ulcers on their legs.

PAD

The defining symptom of PAD is intermittent claudication, which refers to severe leg cramping following intense physical activity, as well as fatigue, pressure, and weakness linked to the cramps. This may reduce a person’s walking distance, but claudication typically feels better after resting.

Other PAD leg symptoms include:

  • problems getting or keeping an erection, which may be more common early on
  • hair loss on the feet and legs
  • numbness
  • weakness
  • a “shiny” quality to the skin
  • a weak pulse in the leg
  • muscle wasting
  • legs with lighter skin may turn pale blue, although this might not be as apparent in people with a darker skin tone

In its most severe form, PAD may lead to gangrene and limb loss, poor circulation to the kidneys, and an increased risk of stroke or heart attack death. However, people may not experience symptoms of early or mild PAD at all.

Atherosclerosis, which mainly occurs in arteries and not veins, is the main difference between the causes of PVD and PAD. PAD most often occurs due to atherosclerosis, while this is rarer in PVD as it involves veins.

PVD causes and risk factors

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

Chronic venous insufficiency usually occurs due to a faulty valve in the vein.

It is one of the most common types of PVD and occurs especially frequently in females. According to a 2024 paper, chronic venous insufficiency affects 1% to 17% of males but 1% to 40% of females.

Varicose veins are also widespread, occurring in up to 70% of people, although this figure may vary based on a country’s guidelines around what constitutes a varicose vein.

Along with being female, people with the following risk factors might be more likely to develop chronic venous insufficiency:

PAD causes and risk factors

According to a 2018 study, atherosclerosis is more likely to develop in arteries than veins due to the type of blood that flows through them.

The following are the main arteries in which atherosclerosis slowly develops and may cause PAD:

  • abdominal aorta
  • iliac
  • femoral

The American Heart Association (AHA) advises that the risk factors for PVD include:

  • being under 50 years of age with type 2 diabetes and another risk factor for atherosclerosis
  • being 50 to 64 years of age with other risk factors for atherosclerosis
  • being over 65 years of age
  • diabetes
  • family history of PAD
  • high blood pressure
  • high cholesterol
  • having a previous diagnosis of atherosclerosis in the heart, brain, or kidney blood vessels
  • a lifestyle that does not include much exercise
  • smoking

According to the United Kingdom’s National Health Service (NHS), people should speak to a healthcare professional if they regularly experience leg pain during exercise, as this would not likely occur in an otherwise healthy person.

People with varicose veins usually do not need to speak to a healthcare professional unless they hurt, itch, or swell up. They should also consult a healthcare professional about any sores on the leg that do not heal within 14 days.

Treatments are available for both conditions, although they differ.

PVD treatment

Lifestyle changes and at-home treatments for PVD might include:

Medical and surgical treatments for PVD are also available, including:

  • sclerotherapy, an injection of a special foam that can reduce varicose, reticular, and spider veins
  • endovenous thermal ablation, which involves using heat to close veins from the inside that do not work well
  • stenting, which holds veins open using a tiny tube
  • surgical stripping, in which a surgeon ties off and removes veins to improve severe varicose vein symptoms
  • valve reconstruction, in which surgeons replace valves in veins that are not functioning

PAD treatment

Treatments for PAD may involve lifestyle adjustments, including:

  • increasing exercise, including walking with frequent stops to account for intermittent claudication
  • quitting smoking
  • maintaining a moderate weight
  • reducing alcohol intake
  • eating a heart-healthy diet
  • managing anxiety or depression related to the effects of PAD on daily life
  • diabetes management, such as medications

Medications for PAD might include:

Two main procedures can help PAD:

  • angioplasty, which widens a blocked blood vessel using a tiny balloon
  • artery bypass graft, which involves bypassing the blockage with blood vessels from elsewhere in the body

Can you have PVD without PAD?

PAD is a type of PVD, so they would technically always occur at the same time. However, PAD and other types of PVD can occur together or separately, as they share some but not all risk factors.

Can you have PVD and PAD at the same time?

PAD can occur at the same time as other types of PVD, such as chronic venous insufficiency. According to a 2020 study, people with advanced PAD were more likely to have chronic venous insufficiency at the same time.

Can you prevent PVD or PAD?

Many people can prevent PAD in the following ways:

  • not smoking
  • increasing physical activity
  • eating a heart-healthy diet that prioritizes fruits, vegetables, and whole grains and limits sodium, saturated and trans fats, sugary drinks, and red meat
  • taking any prescribed medications for cholesterol, blood pressure, or blood sugar management

Peripheral artery disease (PAD) is a type of peripheral vascular disease (PVD). However, other types of PVD, such as chronic venous insufficiency, lead to different symptoms, occur for different reasons, and require different treatments. PAD mainly causes intermittent claudication, while chronic venous insufficiency leads to spider, reticular, and varicose veins.

PAD mainly develops due to atherosclerosis, while faulty valves in veins generally contribute to chronic venous insufficiency. They share some risk factors, such as sedentary lifestyles and smoking, but chronic venous insufficiency is more common in females than males, and high blood pressure and cholesterol levels may lead to atherosclerosis and PAD.

Exercise, rest, not smoking, and a heart-healthy diet can treat early stages of both, but PAD may need medications, angioplasty, or an artery bypass, and compression socks, sclerotherapy, endovenous ablation, stripping, or valve reconstruction may be necessary depending on the stage of chronic venous insufficiency.