Peripheral Arterial vs Venous Disease

Medical-Surgical · Cardiovascular·Updated 2026-10-27

What it is

Peripheral artery disease (PAD) is atherosclerotic narrowing of the arteries to the legs, so tissues receive too little oxygenated blood, especially during activity. Chronic venous insufficiency (CVI) is failure of the venous valves, so blood pools and venous pressure rises in the lower legs. One rule guides care: arterial disease needs gravity to bring blood in (legs dependent), venous disease needs gravity to drain blood out (legs elevated).

What the NCLEX focuses on

PAD: intermittent claudication (cramping calf pain with walking, relieved by rest), rest pain at night relieved by dangling the legs, weak or absent pulses.
PAD skin: cool, pale, shiny, hairless, thick toenails, elevation pallor and dependent rubor; painful ulcers on toes or pressure points with a pale, deep, "punched-out" base.
CVI: aching heaviness, edema worse at the end of the day, reddish-brown skin (hemosiderin), stasis dermatitis, pulses present.
Venous ulcers: shallow, irregular edges, moist red base, heavy drainage, above the medial malleolus.
Acute arterial occlusion (6 Ps: pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia) is an emergency.
DVT differs from CVI: unilateral calf swelling, warmth, redness and tenderness; never massage the leg.
PAD treatment: supervised exercise therapy, smoking cessation, antiplatelet therapy, statin, cilostazol for claudication.

Priority nursing actions

Compare pulses, color, temperature, capillary refill and sensation in both legs with the baseline.
Report signs of acute occlusion (new pulselessness, pallor, paresthesia) immediately.
Position the PAD leg level or dependent; elevate the CVI leg above heart level.
Protect the feet and skin; apply prescribed compression only after arterial disease is excluded.
Provide ulcer care specific to the ulcer type and assess for infection.

Numbers to know

Measure	Value	Why it matters
Ankle-brachial index (ABI), normal	1.00 to 1.40	Ankle pressure equal to or above arm pressure
ABI, PAD	0.90 or less	Confirms PAD
ABI, severe	0.40 or less	Associated with rest pain and tissue loss
Capillary refill	Less than 3 seconds	Prolonged in arterial disease
Supervised exercise	30 to 45 minutes, at least 3 times a week, for at least 12 weeks	Lengthens pain-free walking distance

Common exam traps

Choosing to elevate PAD legs above the heart: wrong because it further reduces arterial flow and increases pain.
Choosing a heating pad for cold PAD feet: wrong because reduced sensation and perfusion lead to burns.
Choosing compression stockings for a client with PAD: wrong because compression reduces arterial inflow.
Choosing to massage a warm, swollen calf: wrong because it can dislodge a DVT and cause pulmonary embolism.
Choosing strict bed rest for claudication: wrong because walking to moderate pain, resting, then resuming builds collateral circulation.

What to teach

PAD: inspect the feet daily with a mirror, wear clean socks and closed shoes, never walk barefoot, apply lotion but not between the toes.
Stop all tobacco and nicotine use; walk daily, resting when pain starts, then continuing.
CVI: put on compression stockings in the morning before swelling, elevate the legs, and avoid long standing or sitting.
Avoid crossing the legs and tight clothing around the waist and thighs.

Client handout: Preventing Blood Clots (DVT) (nurse guide and printable patient handout).

Try 2 NCLEX-style questions on this topic

From the NCLEXPace question bank. Pick your answers, then check them inside NCLEXPace.

Question 1 · QID B1D387FA

The nurse compares the leg findings of two clients. For each finding, indicate whether it points to peripheral artery disease or chronic venous insufficiency.

	Peripheral artery disease	Chronic venous insufficiency
Cramping calf pain with walking that stops with rest
Swelling of the ankle that is worse at the end of the day
Reddish-brown skin above the inner ankle
Absent pedal pulses with capillary refill over 3 seconds
Shallow ulcer with a moist pink base above the inner ankle
Thin, shiny, hairless skin with thick toenails

Question 2 · QID 319CCE15

The nurse is supervising an assistive personnel (AP) who is caring for a client with peripheral artery disease. Which statement by the AP demonstrates correct understanding of the client's care?

Select the best answer.

A. “I will raise the client's legs on pillows above the heart when the calf pain starts.”
B. “I will place a heating pad on the client's feet because they feel cold.”
C. “I will check the client's foot pulses and decide if the client can walk today.”
D. “I will walk the client in the hallway and let the client rest when the calf pain starts.”

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Sources

Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Vascular Disorders.
Gornik HL, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease. Circulation. 2024;149(24):e1313-e1410.

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