Peripheral Vascular Disease vs. Venous Insufficiency: What’s the Difference?

Peripheral vascular disease (PVD) and venous insufficiency are two distinct yet interconnected conditions that affect the blood vessels in the body. While they both impact circulation, they have different causes, symptoms, and implications for overall health. This article will explore the differences between peripheral vascular disease and chronic venous insufficiency, their respective characteristics, and the importance of early detection and management.

Understanding Peripheral Vascular Disease (PVD)

Peripheral vascular disease, also known as peripheral artery disease (PAD), is a slow and progressive circulatory condition resulting from the narrowing or blockage of the blood vessels outside the heart. According to Johns Hopkins Medicine, this narrowing is often caused by atherosclerosis, a condition characterized by the buildup of fatty deposits and plaque on the artery walls. As a result, blood flow to the limbs, particularly the legs, is reduced, thus decreasing the oxygen and nutrients available to the tissue.

Blood clots can also develop on artery walls, further reducing the blood vessel's inner diameter and potentially causing blockages in major arteries. Called arterial thrombosis, this blockage of blood flow to the heart or brain can be fatal.

Common symptoms of PVD include:

• Leg pain or cramping during physical activity (called intermittent claudication)
• Coldness in the lower leg or foot
• Weak pulse in legs and feet
• Numbness or weakness in the legs
• Skin changes, including paleness or reddish-blue color of extremities
• Brittle, shiny skin
• Decreased skin temperature
• Slower toenail growth
• Impotence
• Hair loss on the legs
• Non-healing wounds and ulcers

Understanding Venous Insufficiency

Chronic venous insufficiency (CVI), on the other hand, is a condition that occurs when the veins in the legs have difficulty returning blood to the heart. This can be due to weakened or damaged valves in the veins, which prevent blood from flowing backward. As a result, blood pools in the legs, causing various symptoms.

Symptoms of chronic venous insufficiency can be categorized into three main groups:

• Physical discomfort: leg pain, swelling, aching, or cramping,
• Sensory changes: itching and tingling, and feelings of heaviness in the legs
• Visible skin changes: varicose veins, skin discoloration, and ulcers

Key Differences Between Peripheral Vascular Disease & Venous Insufficiency

1. Vascular Involvement: PVD primarily affects arterial vessels, while venous insufficiency impacts the venous system. PVD is associated with atherosclerosis and arterial blockages, reducing blood flow to the limbs. In contrast, venous insufficiency is related to dysfunctional vein valves and impaired blood return to the heart.
2. Symptoms: PVD often manifests as pain or discomfort during physical activity due to inadequate blood supply to the muscles (intermittent claudication). Venous insufficiency symptoms include leg swelling, aching or cramping, and skin changes such as varicose veins and ulcers.
3. Risk Factors: While some risk factors overlap, such as age and a sedentary lifestyle, PVD is more strongly associated with conditions like diabetes, high cholesterol, and smoking. Venous insufficiency risk factors include family history, obesity, pregnancy, and prolonged sitting or standing.
4. Complications: If left untreated, PVD can lead to severe complications such as non-healing wounds and limb amputation due to reduced blood flow to the affected limbs. Venous insufficiency can result in chronic swelling, skin changes, and slow-healing ulcers due to impaired venous return.

Diagnosis and Management

Diagnosing PVD and venous insufficiency typically involves a combination of medical history assessment, physical examination, and non-invasive tests such as ankle-brachial index (ABI) for PVD and duplex ultrasound for venous insufficiency. Management strategies for both conditions focus on relieving symptoms, slowing disease progression, and reducing the risk of complications.

Peripheral Vascular Disease

According to the Mayo Clinic, tests to diagnose PAD include:

• Blood tests. Blood tests check for conditions such as high cholesterol, high triglycerides, and diabetes.
• Ankle-brachial index (ABI). This standard test compares the blood pressure in the ankle with the blood pressure in the arm.
• Ultrasound of the legs or feet. This test uses sound waves to see how blood moves through the blood vessels. Doppler ultrasound is a particular type of ultrasound used to spot blocked or narrowed arteries.
• Angiography. This test uses X-rays, magnetic resonance imaging (MRI) scans, or computerized tomography (CT) scans to look for artery blockages.

Lifestyle modifications such as regular exercise, smoking cessation, and healthy eating are essential. Medications to control cholesterol levels and blood pressure may also be prescribed. In advanced cases, procedures may be necessary to restore adequate blood flow to the affected limbs.

Surgical procedures for PAD include:

1. Angioplasty and Stent Placement: A procedure where a catheter is used to open clogged arteries. A balloon is inflated to widen the artery, and a stent may be placed to keep it open.
2. Bypass Surgery: Redirects blood flow around a blocked artery using a healthy blood vessel or synthetic material.
3. Cryoplasty: Uses liquid nitrous oxide to freeze and dilate the artery, reducing the likelihood of reoccurrence.
4. Percutaneous or Laser Atherectomy: Removes plaque buildup from the artery using specialized catheters.

Venous Insufficiency

In the case of venous insufficiency, lifestyle modifications such as elevating the legs, wearing compression stockings to improve circulation, and regular exercise are usually recommended to promote healthy blood flow. Additionally, maintaining a healthy weight and avoiding prolonged periods of standing or sitting can help alleviate symptoms.

For a more lasting and complete resolution to the pain and disfigurement of varicose veins, minimally invasive procedures may be recommended to close off or remove damaged veins, improving blood flow and reducing symptoms. These procedures

Common diagnostic tests for venous insufficiency include:

1. Physical Examination: A thorough physical examination is often the first step in diagnosing CVI. The doctor will assess symptoms such as swelling, varicose veins, skin changes, and ulcers. They may also evaluate the patient's medical history and risk factors.
2. Duplex Ultrasound: Duplex ultrasound is a non-invasive imaging test that combines traditional ultrasound with Doppler ultrasound. It allows visualization of blood flow in the veins and can identify areas of reflux (backward flow) or blockage.
3. Venography: Venography is an imaging test that involves injecting a contrast dye into the veins, followed by X-rays to visualize blood flow and detect any abnormalities or blockages.
4. CT or MRI Venography: These imaging tests may be used in cases where conventional venography is not feasible or to provide additional information about the venous system.

Office-based treatment options for venous insufficiency include:

• Ultrasound-guided foam sclerotherapy: Medication is injected into the problem vein using ultrasound guidance.
• Varithena: during this catheter-based procedure, an injection of microfoam causes the affected veins to collapse. Blood is rerouted to healthier veins.
• Endovenous ablation (EVLA): a nonsurgical, minimally invasive procedure that uses heat to close problem veins. Options include laser ablation and radiofrequency ablation.
• Ambulatory phlebectomy: An outpatient procedure during which diseased veins are removed through tiny incisions that require only a band-aid to cover.

Individuals with venous insufficiency need to work closely with a qualified vein specialist to develop a personalized treatment plan tailored to their specific needs and symptoms. Regular monitoring and follow-up appointments are essential to assess treatment effectiveness and make necessary adjustments.

Center for Vein Restoration (CVR) is a nationally recognized leader in treating venous diseases, including varicose veins and spider veins. They offer a variety of nearly pain-free solutions to eliminate the root causes of unsightly and uncomfortable leg veins. All CVR vein centers are accredited, evaluated, and approved by the Intersocietal Accreditation Commission. A team of world-renowned and respected vein care practitioners provides state-of-the-art venous care.

Call 240-965-3915 to speak to a Patient Services Representative or schedule your consultation online at a CVR near you today.

Importance of Early Detection and Treatment

Early detection and treatment of both peripheral vascular disease (PVD) and venous insufficiency are crucial in preventing complications and preserving overall health. Timely intervention can help alleviate symptoms, slow disease progression, and reduce the risk of serious complications such as non-healing wounds, ulcers, blood clots, and limb amputation (in the case of PAD).

By seeking medical attention at the first signs of symptoms, individuals can receive appropriate diagnostic tests and personalized treatment plans to manage these conditions effectively. Proactive monitoring and lifestyle modifications can significantly improve outcomes and quality of life for individuals with PVD and venous insufficiency.

Trust the Venous Health Experts at Center for Vein Restoration

While peripheral vascular disease and venous insufficiency share some common features, they are distinct conditions with different causes, symptoms, and management approaches. If you suspect that venous insufficiency is the cause of your leg discomfort or unsightly leg veins, CVR is your answer!

America’s largest physician-led vein center, Center for Vein Restoration, offers comprehensive treatment for chronic venous insufficiency at over 110+ clinics in 22 states by 70+ board-certified vein physicians. CVR consistency boasts a 98 percent patient satisfaction rating.

CVR accepts many insurances, including Aetna, Amerigroup, Anthem, Blue Cross/Blue Shield, Cigna, MultiPlan, Medicaid, Medicare, and more.

Call 240-965-3915 to speak to a Patient Services Representative or schedule your consultation online at a CVR near you today.