(This Self Study Series was
prepared by Dr. Tse Cheuk Chad, Specialist in General Surgery, Vascular
Surgeon.)
Introduction
Venous disease has very diverse clinical presentation, ranging from simple
spider veins, unsightly varicose veins to debilitating venous ulcer. All of
these are now grouped under the term Chronic
Venous Disorder (CVD). In the US, it is estimated that 10-35% of the adult
population has some form of CVD. The problem is more common in women as a
result of pregnancy and child bearing.
Although
it is rarely a life- or limb-threatening problem, the disease greatly impacts
quality of life. Many people affected are in their most productive years of
life. They usually seek medical advice for cosmetic and health concerns.
This article will describe the current
classification and diagnosis of CVD. Treatment with emphasis on minimally
invasive therapy will be discussed in the next issue.
Classification
of for Chronic Venous Disorder (CEAP)
The CEAP
classification was introduced by the American Venous Forum in 1994 and was
revised in 2004. It is now widely adopted around the world and is considered as
the reporting standard for venous disease nowadays. The goal was to stratify
clinical levels of venous insufficiency. The four categories selected for
classification were: clinical state (C), etiology (E), anatomy (A), and
pathophysiology (P). The CEAP classification helps to provide guidance in
choosing the appropriate treatment for such patients.
The
Clinical Classification (C1,2,3,4,5,6,A,S)
The
Clinical classification is the foundation of the concept. The six CVD
categories range from small, thread-like veins to edema, discoloration,
induration, and ulceration. Each is clearly defined in Table 1.C-0 is
appropriate for those individuals with objective evidence of venous disease
(i.e. E,A, and/or P), but with no clinical manifestations. The extent of
varicose disease, along with the other clinical findings is categorized in the
severity score. For clinical class 4 is now subdivided into (a) pigmentation
and/or eczema, and (b) lipodermatosclerosis and/or atrophie blanché, based upon
observational survey data suggesting that lipodermatosclerosis or atrophie
blanché (4b) was more likely to progress to more severe disease.
Subscripts
are applied to designate S (symptomatic) from A (asymptomatic) limbs.
Complaints qualifying for the S subscript include aches, pain, tightness, skin
irritation, heaviness, muscle cramps, and other complaints that may be
attributable to venous dysfunction.
(continue...)
Reference information: http://veno.com.hk
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your doctor for diagnosis and treatment.
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