Peripheral Arterial Disease vs. Peripheral Venous Disease

Key Differences

• Focus on how patients present with arterial vs. venous disease.
• Use the mnemonic VESSEL to remember the differences.

V: Various Positions

• Arterial Disease:
  • Preferred Position: Dangling legs to improve blood flow to extremities.
  • Pain Worsens: When legs are elevated.
• Venous Disease:
  • Preferred Position: Elevating legs to decrease swelling and aid blood return to the heart.
  • Pain Worsens: When sitting or standing for long periods.

E: Explanation of Pain

• Arterial Disease:
  • Pain Type: Sharp, worse at night (rest pain), intermittent claudication.
  • Occurrence: Pain with activity, relieved by rest due to poor blood flow.
• Venous Disease:
  • Pain Type: Heavy, dull, throbbing, aching.
  • Occurrence: Worse with standing or sitting with legs dangled.

S: Skin of the Lower Extremity

• Arterial Disease:
  • Appearance: Cool, thin, dry, scaly, hairless, thick toenails.
  • Color Changes: Rubor when legs are dangled, pale when elevated.
• Venous Disease:
  • Appearance: Warm, thick, tough, swollen, brownish color.

S: Strength of Pulse

• Arterial Disease:
  • Pulse: Poor or absent due to compromised circulation.
  • Assessment: Use Doppler to grade pulse.
• Venous Disease:
  • Pulse: Present and typically normal.

E: Edema

• Arterial Disease:
  • Presence: Uncommon.
• Venous Disease:
  • Presence: Common, worsens by the end of the day.

L: Lesions (Ulcers)

• Arterial Ulcers:
  • Location: Toes, dorsum of feet, lateral malleolus.
  • Appearance: Little drainage, pale or necrotic, "punched out" look, deep and round.
• Venous Ulcers:
  • Location: Medial lower legs, medial malleolus.
  • Appearance: Swollen, edema, drainage, pink to deep red base, irregular and shallow edges.

Conclusion

• This information provides a comprehensive comparison of PAD and PVD to assist with patient assessment and exam preparation.