Chart — Med-Surg
Arterial vs Venous Insufficiency Chart
One distinction drives the whole comparison: arterial disease is a supply problem (blood can’t get in), venous disease is a drainage problem (blood can’t get out). Everything else — pain, skin, ulcers, and especially positioning — follows from that.
Educational use only. Mixed arterial-venous disease exists; assess arterial supply (ABI) before applying compression or elevation strategies. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Side-by-Side Comparison
| Feature | Arterial (PAD) | Venous Insufficiency |
|---|---|---|
| Core problem | Blood can't get IN — poor arterial supply | Blood can't get OUT — poor venous return |
| Pain | Intermittent claudication (with walking); rest pain when severe; worse with elevation | Dull ache, heaviness, throbbing; worse with prolonged standing/dependency |
| Relieved by | Rest and dependency (dangling the leg) | Elevation and compression |
| Pulses | Diminished or absent | Usually present |
| Skin / temperature | Cool, pale, shiny, hairless; thick nails; dependent rubor, elevation pallor | Warm; brown hemosiderin staining; possible stasis dermatitis |
| Edema | Minimal | Prominent — worsens through the day |
| Ulcer location | Toes, lateral foot, pressure points | Medial ankle (gaiter area) |
| Ulcer appearance | Round, 'punched-out,' pale base, well-defined; very painful | Irregular, shallow, ruddy/granulating, weepy; mildly painful |
| Positioning | Neutral or slightly dependent — do NOT elevate | Elevate above heart; compression therapy |
| Key test | Ankle-brachial index (ABI ≤0.90) | Duplex ultrasound; clinical exam |
Exam Traps
- ✦Positioning is the #1 trap: arterial legs go DOWN (dependent), venous legs go UP (elevated).
- ✦Compression therapy helps venous disease but can harm a poorly perfused arterial limb — check the ABI first.
- ✦Cool, pale, hairless, pulseless, painful = arterial; warm, brown-stained, edematous, pulses present = venous.
- ✦Ulcer site sorts them fast: toes/lateral foot = arterial; medial ankle = venous.
- ✦Pain that improves when the leg hangs down points arterial; pain that improves with elevation points venous.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →