Understanding the Circulation System
Arteries and veins play very different roles in the circulatory system. Arteries carry oxygen-rich blood from the heart to your muscles and organs. Veins return the oxygen-depleted blood back to the heart. While both can contribute to leg pain, they do so in different ways. Understanding which system is involved is the key to choosing the right treatment.
What Is Artery Disease?
Artery disease, or peripheral artery disease (PAD), happens when the arteries supplying blood to the legs become narrowed or blocked by plaque (atherosclerosis). This restricts blood flow and oxygen to leg muscles, especially during activity.
Who Gets Arterial Disease?
- People with diabetes
- Smokers or former smokers
- Those with high blood pressure or high cholesterol
- Individuals with metabolic syndrome
- People over the age of 65, especially with a history of heart or vascular disease
Common Symptoms of Arterial Disease
- Cramping or aching pain in the calves or thighs after walking (claudication)
- Leg pain at night, especially relieved by dangling the foot over the bed (rest pain)
- Shiny or thin skin on the legs
- Sores or ulcers that don’t heal well on the feet or toes
- Weak or absent pulses in the feet
What Is Vein Disease?
Vein disease occurs when valves in the veins fail to work properly. This leads to pooling of blood in the legs and increased venous pressure, a condition known as chronic venous insufficiency (CVI).
Who Gets Vein Disease?
- People with a family history of varicose veins
- Women who have had multiple pregnancies
- People who are overweight or obese
- Individuals who spend long periods standing or sitting
- Those with a history of blood clots or prior leg trauma
Common Symptoms of Vein Disease
- Aching, throbbing, or heavy sensation in the legs
- Swelling of the ankles and calves, especially by the end of the day
- Visible varicose or spider veins
- Itching or discoloration of the lower legs
- Leg ulcers, typically near the ankles
What About Deep Vein Thrombosis (DVT)?
Another form of vein disease is deep vein thrombosis (DVT), where a blood clot forms in a deep vein, usually in one leg.
- Sudden leg pain, swelling, or tenderness—often in one leg only
- Skin that feels warm to the touch
- Reddish or bluish skin discoloration
DVTs are life-threatening but easily treated if diagnosed early. Seek medical attention immediately if you suspect a DVT.
Diagnosis: How to Know the Difference
The best way to determine whether your leg pain is from artery disease or vein disease is through diagnostic testing. At San Francisco Vein Center, we may use:
- Ankle-Brachial Index (ABI): Compares blood pressure in the legs vs arms to screen for arterial blockages
- Ultrasound vein evaluation: Assesses blood flow and valve function in the veins
Treatment Options
- For Arterial Disease: Lifestyle changes, medications, or procedures to open blocked arteries (e.g., angioplasty or stenting)
- For Vein Disease: Compression therapy, lifestyle changes, or procedures like radiofrequency ablation and sclerotherapy
- For DVT: Anticoagulants (blood thinners), sometimes thrombolysis or filter placement
Bottom Line
If you’re experiencing leg pain—especially if it’s chronic, worsens with activity, or is associated with swelling or skin changes—it’s important to find out the cause. Both artery and vein disease are treatable, especially when diagnosed early.