From the Guidelines
No, having signs of chronic venous insufficiency (CVI) does not necessarily mean a patient has peripheral arterial disease (PAD). These are distinct vascular conditions affecting different parts of the circulatory system, as outlined in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1. CVI involves damaged valves in the veins, leading to blood pooling in the lower extremities with symptoms like edema, skin changes, and varicose veins. PAD, conversely, results from arterial narrowing that reduces blood flow to the limbs, causing symptoms like claudication, decreased pulses, and cool extremities.
The diagnosis of PAD is typically accomplished through the history, physical examination, and resting ankle-brachial index, as stated in the guideline 1. A patient can have one condition without the other, though some patients may have both simultaneously (mixed arterial and venous disease). The physical examination findings differ significantly: CVI typically presents with dependent edema, brownish skin discoloration, and sometimes ulcers near the ankles, while PAD presents with diminished pulses, pallor on elevation, and pain with exertion.
Key differences in presentation and diagnosis include:
- CVI symptoms: edema, skin changes, varicose veins
- PAD symptoms: claudication, decreased pulses, cool extremities
- Diagnostic tests: ankle-brachial index for PAD and venous duplex ultrasound for CVI. Effective medical therapies for patients with PAD should be prescribed to prevent major adverse cardiovascular events and major adverse limb events for patients with or at risk of developing PAD, as recommended by the guideline 1.
From the Research
Relationship Between CVI and PAD
- The presence of chronic venous insufficiency (CVI) does not necessarily mean a patient has peripheral artery disease (PAD) 2, 3.
- However, studies suggest that patients with CVI are more likely to have PAD, especially those with severe forms of CVI 3, 4.
- The frequency of PAD in patients with CVI can range from 17% to 21% 3, 4.
Risk Factors for CVI and PAD
- Common risk factors for both CVI and PAD include high Body Mass Index (BMI), hypertension, and positive family history 3, 4.
- Diabetes is also a significant risk factor for PAD, and obesity is more common in patients with co-existing PAD and CVI 4.
Diagnosis and Management
- It is essential to determine the Ankle Brachial Pressure Index (ABPI) in patients with severe CVI to exclude the presence of PAD 3.
- Concomitant CVI can be under-diagnosed in patients with PAD, and signs of possible CVI can be seen in approximately one-fifth of patients with known or suspected PAD examined with run-off MR angiography 4.
- Early diagnosis and management of CVI are crucial to prevent complications and improve patient quality of life 5, 6.