CEAP Classification Of Venous Disorders Article - StatPearls

Issues of Concern · C0 No visible or palpable signs of venous disease · C1 Telangiectasies or reticular veins · C2 Varicose veins; distinguished ... CEAPClassificationOfVenousDisorders MedicalReference CEAPClassificationOfVenousDisorders FreeReviewQuestions Definition/Introduction DuringtheFifthAnnualMeetingoftheAmericanVenousForum1993,JohnPortersuggestedaclassificationforvenousdisease,justliketheTNM(tumor/node/metastasis)classificationforcancer.In1994,theAmericanVenousForumcreatedaclassificationsystemtoaiduniversallyuniformdiagnosisandcomparisonofchronicvenousdisorders.In1995,theclassificationwasincorporatedintothe“ReportingStandardsinVenousDisease.” In2004theclassificationunderwentrevision,whichretainedthebasicCEAPcategoriesbutimprovedtheunderlyingdetails. ThenameCEAPclassificationstandsforClinical(C),Etiological(E),Anatomical(A),andPathophysiological(P).[1][2][3] IssuesofConcern Sevenclinicalcategoriesarerecognizedasbelow:[1][2][4] C0Novisibleorpalpablesignsofvenousdisease C1Telangiectasiesorreticularveins C2Varicoseveins;distinguishedfromreticularveinsbyadiameterof3mmormore C3Edema C4ChangesinskinandsubcutaneoustissuesecondarytoCVD C4aPigmentationoreczema C4bLipodermatosclerosisoratrophieblanche C5Healedvenousulcer. C6Activevenousulcer. S:Symptomatic A:Asymptomatic Theetiologicalclassificationdividesinto: Ec:Congenital Ep:Primary Es:Secondary En:Novenouscauseidentified Anatomicalclassificationdividesintofourcategories: As:superficialveins Ap:perforatingveins Ad:deepveins An:novenouslocationidentified Lastisthepathophysiologyclassification,dividedintofourcategories: Pr:Reflux Po:obstruction Pr,o:refluxandobstruction Pn:novenouspathophysiologyidentifiable InadvancedCEAPclassification,thereisanadditionof18namedvenoussegmentstolocatethevenouspathology.[1] Superficialveins Telangiectasiesorreticularveins Greatsaphenousveinabovetheknee Greatsaphenousveinbelowknee Smallsaphenousvein Nonsaphenousveins Deepveins Inferiorvenacava Commoniliacvein Internaliliacvein Externaliliacvein Pelvic:gonadal,broadligamentveins,other Commonfemoralvein Deepfemoralvein Femoralvein Poplitealvein Crural:anteriortibial,posteriortibial,peronealveins(allpaired) Muscular:gastrocnemius,solealveins,other Perforatingveins: Thigh Calf ClinicalSignificance BeforetheCEAPclassification,thediagnosisofchronicvenousdisorderlackedprecisionindiagnosis.Thisproblemhadledtoreportingerrorsinstudiesofthemanagementofvenousproblems.CEAPclassificationwasthenadoptedworldwide,providingauniversallyunderstandabledescription,anditbecameaninstrumenttostandardizethediagnosisandallowbettercommunicationofchronicvenousdisorderdiagnosisbetweenhealthcareprofessionals.Accurateclassificationandproperdiagnosisofthediseasewillhelptocreateabaseforbettermanagementforthiscondition.[1][5]ExampleoftheCEAPclassificationapplication:Apatientcomesinwithswellingandtightnessoftheleg.Onphysicalexamination,theexaminerobservesvaricoseveins,lipodermatosclerosis,andhealedulceration.Theduplexscanningreportshowsgreatsaphenousveinrefluxandpoplitealandanteriortibialreflux.Signsofpostthromboticobstructionarenegative. CEAPClassification:C2,3,4b,5,S,Ep,As,d,Pr Nursing,AlliedHealth,andInterprofessionalTeamInterventions TheuseofCEAPclassificationresultsinanorganizedcategorizationofthecriticalelementsofthevenousabnormalitiesandclarifiestheinterrelationshipsbetweenthecauses,clinicalmanifestations,andanatomicdistribution.Therefore,thisclassificationmethodwillhelpfacilitateinterinstitutionalstudies.[6]TodeterminetheCEAPclassificationrequiresaninterprofessionalteamofhealthcareprofessionals,including clinicians,mid-levelpractitioners,nurses,andspecialists indifferentspecialtiessuchasinternists,cardiologists,andradiologists.Besidesdoingathoroughphysicalexaminationtodeterminetheclinicalcategoriesofthepatient,itisessentialtohaveaclearmedicalhistoryofthepatienttocomeupwiththeetiologyofthedisease.Toidentifyspecificsitesofvenousobstruction,duplexultrasound,computedtomographic(CT),magneticresonance(MR),orcatheter-basedcontrastvenographyareused.[7] [Level1] ArticleDetails ArticleAuthor TedZegarra ArticleEditor: PrasannaTadi Updated: 4/6/20216:27:19PM Feedback: SendUsYourComments PubMedLink: CEAPClassificationOfVenousDisorders References [1] EklöfB,RutherfordRB,BerganJJ,CarpentierPH,GloviczkiP,KistnerRL,MeissnerMH,MonetaGL,MyersK,PadbergFT,PerrinM,RuckleyCV,SmithPC,WakefieldTW,RevisionoftheCEAPclassificationforchronicvenousdisorders:consensusstatement.Journalofvascularsurgery.2004Dec;  [PubMedPMID:15622385] [2] LurieF,PassmanM,MeisnerM,DalsingM,MasudaE,WelchH,BushRL,BlebeaJ,CarpentierPH,DeMaeseneerM,GasparisA,LabropoulosN,MarstonWA,RafettoJ,SantiagoF,ShortellC,UhlJF,UrbanekT,vanRijA,EklofB,GloviczkiP,KistnerR,LawrenceP,MonetaG,PadbergF,PerrinM,WakefieldT,CEAPclassificationsystemandreportingstandard,revision2020.Journalofvascularsurgery.Venousandlymphaticdisorders.2020Feb26;  [PubMedPMID:32113854] [3] WaheedSM,KudaravalliP,HotwagnerDT,DeepVeinThrombosis(DVT)2020Jan;  [PubMedPMID:29939530] [4] MeissnerMH,GloviczkiP,BerganJ,KistnerRL,MorrisonN,PannierF,PappasPJ,RabeE,RajuS,VillavicencioJL,Primarychronicvenousdisorders.Journalofvascularsurgery.2007Dec;  [PubMedPMID:18068562] [5] EklöfB,CEAPclassificationandimplicationsforinvestigations.ActachirurgicaBelgica.2006Nov-Dec  [PubMedPMID:17290688] [6] KistnerRL,EklofB,MasudaEM,Diagnosisofchronicvenousdiseaseofthelowerextremities:the  [PubMedPMID:8637255] [7] SouroullasP,BarnesR,SmithG,NandhraS,CarradiceD,ChetterI,Theclassicsaphenofemoraljunctionanditsanatomicalvariations.Phlebology.2017Apr  [PubMedPMID:26924361]