Update in Diagnosis and Treatment for Varicose Veins (Part 1-1)

(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.

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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.