What is the Difference Between Venous Disease and Peripheral Artery Disease?

Peripheral Arterial Disease (PAD) and venous disease are two very distinct disease states with different causes, symptoms and care pathways. Depending on the patients’ conditions, there may be some similarities in the treatment of the two diseases.

Conditions and Causes

Peripheral arterial disease, or PAD, is a condition where the muscles of the legs suffer from a restricted blood supply[1]. PAD is caused by plaque; fatty materials and cholesterol that build up inside the arteries. This plaque will begin to narrow and block the arteries, restricting the flow of oxygen and other nutrients to the lower limbs. PAD can also be called peripheral vascular disease, or PVD, and is a common form of cardiovascular disease[1].

People are more at risk of PAD as they age. It is believed that there are over 8 million PAD sufferers in the US alone and millions more around the world. It is more common in men than women and in people over the age of 50. Hispanics and African Americans are also particularly at risk. Contributing factors include smoking, diabetes, high cholesterol and high blood pressure.

Venous disease is a condition that, generally, affects the veins in the lower extremities[2]. It arises from two conditions, venous reflux and/or obstruction. Reflux is when the walls of the veins in the legs deteriorate and the small valves that allow blood to return to the heart become defective. Obstruction, commonly referred to as Venous Outflow Obstruction, is when the blood flow in the vein becomes restricted or blocked. A blood clot, resulting from an injury or surgery, may be responsible for blockage. Other factors contributing to reflux and obstruction include hormones, pregnancy, excess weight, smoking or sitting or standing for too long. Both of these conditions allow blood to pool, and this may create additional pressure in the veins, leading to further damage and healthcare problems for the patient.

Symptoms

middle aged woman suffering from leg painMany PAD sufferers have no symptoms in the early stages. As the disease progresses, and begins to restrict blood flow, individuals may begin to experience aching, painful legs when walking[1]. This discomfort will normally disappear after a short period of rest, a factor known as “intermittent claudication.” Additional symptoms may be resting pain in the feet at night and arterial ulcers. Arterial ulcers are open wounds and infections on the toes and feet. Eventually, untreated and severe PAD can lead to gangrene and limb loss[1].

Symptoms of venous disease include spider and varicose veins, leg pain and swelling and changes to the color of the skin[2] . The affected areas may also become inflamed and irritated, and venous ulcers may be a complication in severe cases[3]. Venous ulcers are shallow wounds that appear on the lower leg in the area of the ankles.

Diagnosis

A comparison between blood pressure in the arm and the ankle will often be used to indicate the likelihood of PAD. This is known as the ankle brachial pressure index. A physical examination may be enough to determine if a patient is suffering from venous disease, and an ultrasound or other imaging modality is needed to confirm the diagnosis and severity of the disease.

Treatment

Compression StockingsPAD can be treated through medication, surgical procedure and changes to lifestyle, such as stopping smoking and exercising regularly. Surgery and medication can improve blood flow, and treatment of underlying causes, such as problems with blood pressure, cholesterol levels and diabetes, will assist. An arterial stent can be used to prevent problems caused by narrowing of the arteries.

Venous disease has a range of treatments depending on the causes and severity. In less severe cases, leg elevation, exercise and compression stockings may be adequate[3] . Some patients will require anticoagulation therapy (blood thinners). More severe cases may require surgical interventions, such as vein ablation, vein stripping, sclerotherapy, catheter-directed thrombolysis and venous stenting[3].

If you suspect that you may suffer from PAD or venous disease, you should contact your physician.

 

References

[1] Facts About Peripheral Arterial Disease and Screening. Vascular Web Organization Web site. https://www.vascularweb.org/practiceresources/screeningeventtoolkit/Documents/Facts-PAD.pdf. Published 2009. Accessed February 27, 2015.

[2] Patient information: Chronic venous disease (Beyond the Basics). Up To Date Web Site. http://www.uptodate.com/contents/chronic-venous-disease-beyond-the-basics. Updated July 8, 2103. Accessed February 27, 2015.

[3] What is Chronic Venous Disease? American Venous Forum Web site. http://www.veinforum.org/patients/what-is-vein-disease/what-is-chronic-venous-disease. Accessed February 27, 2015.

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