Most people hear “poor circulation” and think it’s all the same. But there’s a major difference between two of the most under-diagnosed, misunderstood, and life-altering vascular conditions: Chronic Venous Insufficiency (CVI) and Peripheral Artery Disease (PAD).
The Basics
- CVI is a venous issue — the problem lies in the veins, which are supposed to return blood to the heart. When valves in those veins fail, blood pools in the legs. While this most often affects the lower limbs, pelvic venous insufficiency—a less common but equally disruptive form—can occur in the pelvis, especially in women, and is frequently overlooked or misdiagnosed. It’s also worth noting that pelvic vein congestion can contribute to lower limb symptoms or co-exist with other forms of venous disease.
- PAD is an arterial problem — arteries are the highways that deliver oxygen-rich blood from the heart to the limbs. PAD is usually caused by narrowing or blockage due to atherosclerosis (plaque buildup).
“PAD is not just a circulatory problem; it’s a marker for systemic atherosclerosis and a powerful predictor of heart attack, stroke, and death.”
– American Heart Association, 2022
Why You Need to Know the Difference
- Treatment paths are entirely different. Mistaking one for the other can delay appropriate intervention — and in worst cases, lead to amputation.
- Symptoms overlap. Leg pain, ulcers, swelling, discoloration — both conditions can present similarly. But they’re not twins; they’re more like evil cousins.
- CVI is often overlooked. Most providers (and patients) associate ulcers or skin changes with diabetes or arterial problems — leaving venous disease undiagnosed for years.
Chronic venous insufficiency is a progressive disease that significantly impairs quality of life and functional ability if left untreated.
– Eberhardt & Raffetto, Circulation, 2014
How They Can Co-Exist
Unfortunately, yes — you can have both CVI and PAD. This creates a high-risk scenario:
- Poor arterial flow + poor venous return = catastrophic tissue damage
- In such cases, wound healing becomes nearly impossible without aggressive intervention on both fronts
Key Clues to Distinguish
| Symptom | CVI | PAD |
|---|---|---|
| Pain when walking (claudication) | Rare | Common |
| Pain when legs elevated | Common | Rare |
| Swelling | Common | Rare |
| Skin shiny, hairless | No | Often yes |
| Ulcers above ankle (medial gaiter area) | Yes | Less common |
| Ulcers on toes or feet | Rare | Common |
Bottom Line
If you’ve been told your foot pain, skin changes, or ulcers are “just diabetes” or “just aging,” it may be time to dig deeper. A proper vascular workup can distinguish PAD from CVI — and if you have both, that knowledge could save your legs.
The Vein Signal is here to decode these conditions, share the latest science, and help you advocate for the vascular care you deserve.
Because it’s not just your legs — it’s your life.
References
- Eberhardt, R. T., & Raffetto, J. D. (2014). Chronic venous insufficiency. Circulation, 130(4), 333–346. https://doi.org/10.1161/CIRCULATIONAHA.113.006898
- Criqui, M. H., & Aboyans, V. (2015). Epidemiology of peripheral artery disease. Circulation Research, 116(9), 1509–1526. https://doi.org/10.1161/CIRCRESAHA.116.303849
- Nicolaides, A. N. (2000). Investigation of chronic venous insufficiency: A consensus statement. Circulation, 102(20), e126–e163. https://doi.org/10.1161/01.CIR.102.20.e126
- American Heart Association. (2022). Peripheral Artery Disease (PAD). Retrieved from https://www.heart.org/en/health-topics/peripheral-artery-disease