Nail dystrophy is a distortion and discoloration of normal nail plate structures. It mostly results from fungal infection and associated with various causes, including trauma, psoriasis, lichen planus, and other systemic disorders. Peripheral artery disease (PAD) is a circulatory disease in which narrowed arteries reduce blood supply to the extremities. The signs and symptoms vary from mild ones, such as loss of skin adnexa and pale and cold skin, to intermittent claudication, ulcers, and ischemia. Nailfold capillary microscopy is a method to analyze microvascular abnormalities in rheumatic diseases. The finger-brachial index suggests proximal arterial obstructions when index below 0.7 or an absolute finger pressure less than 70mmHg is observed. A 39-year old man presented with 1-year history of multiple, longitudinal ridging and rough surface on his both 4th, 5th fingernails. He also complained of arthralgia and tingling sensation of fingers. Potassium hydroxide (KOH) preparation for fungus was negative. Laboratory tests and hand X-ray showed normal findings. The patient was referred to rheumatology department for further evaluation. Nailfold capillary microscopy showed irregular distribution of crossed, enlarged capillary loop and avascular areas on the affected fingernails. Finger-brachial index less than 0.7 were observed in most fingers. Herein we report a case of nail dystrophy associated with vascular insufficiency.