What is the difference between Peripheral Artery Disease (PAD) and Peripheral Vascular Disease (PVD)?

From the Guidelines

Peripheral Artery Disease (PAD) and Peripheral Vascular Disease (PVD) are distinct conditions, with PAD specifically referring to atherosclerotic narrowing of arteries outside the heart and brain, primarily affecting the legs, whereas PVD is a broader term encompassing all blood vessel diseases outside the heart, including both arterial and venous conditions. The most recent and highest quality study, 1, published in 2024, emphasizes the importance of detecting PAD through history, physical examination, and the resting ankle-brachial index, and highlights the need for effective medical therapies to prevent major adverse cardiovascular events and major adverse limb events. Key differences between PAD and PVD include:

• PAD is a specific condition characterized by atherosclerotic narrowing of arteries, primarily affecting the legs
• PVD is a broader term that encompasses all blood vessel diseases outside the heart, including both arterial and venous conditions
• Treatment approaches may differ, with PAD often requiring antiplatelet therapy, statins, and blood pressure control, while PVD may require additional treatments such as compression therapy for venous insufficiency. Some key points to consider in the management of PAD and PVD include:
• Lifestyle modifications, such as smoking cessation, regular exercise, and a heart-healthy diet, are essential for both conditions
• Medications, such as antiplatelet drugs, statins, and blood pressure control, are crucial in managing PAD
• Severe cases of PAD may require revascularization procedures, such as angioplasty, stenting, or bypass surgery
• Regular follow-up with a vascular specialist and comprehensive foot care are essential for patients with diabetes and PAD or PVD. According to 1, the 2024 guideline recommends rivaroxaban (2.5 mg twice daily) combined with low-dose aspirin (81 mg daily) as an effective treatment to prevent major adverse cardiovascular events and major adverse limb events in patients with PAD. Overall, while PAD and PVD share some similarities, their distinct differences in terms of definition, diagnosis, and treatment approaches require careful consideration in clinical practice, with a focus on preventing morbidity, mortality, and improving quality of life, as emphasized by 1.

From the Research

Comparison of PAD and PVD

• PAD (Peripheral Artery Disease) and PVD (Peripheral Vascular Disease) are often used interchangeably, but they refer to the same condition: the narrowing or blockage of blood vessels outside the heart [ 2, 3 ].
• PAD is a manifestation of systemic atherosclerosis, affecting 10-15% of the general population, and is often asymptomatic, leading to under-diagnosis and under-treatment [ 4 ].
• The symptoms of PAD are heterogeneous, and a high index of suspicion is needed to prevent delays in diagnosis and treatment [ 5 ].

Diagnosis and Treatment

• The ankle-brachial index (ABI) can be used to screen for and diagnose PAD in the primary care setting [ 3, 6 ].
• Management of PAD includes lifestyle modification, such as smoking cessation and exercise, medical management of atherosclerotic risk factors, and agents to improve walking distance [ 4, 6 ].
• Pharmacotherapy, including statins, antiplatelet agents, and antihypertensive therapy, is also crucial in reducing cardiovascular risk [ 5, 6 ].

Risk Factors and Complications

• The major risk factors for PAD are smoking, diabetes mellitus, hyperlipidemia, hypertension, overweight/obesity, age, male sex, and black race [ 2 ].
• PAD patients are at high risk of major adverse cardiovascular events, and early diagnosis and implementation of secondary cardiovascular prevention is critical [ 5 ].
• Approximately 11% of people with PAD develop chronic limb-threatening ischemia, the most severe form of PAD [ 6 ].