CEAP Classification of Chronic Venous Disorders - Elena ...

CEAP Classification of Chronic Venous Disorders: Let's all speak the same language. · Ep: primary (develops independently of other diseases) · Ec: ... Allpublications Generalconcepts Typesofwoundsandpathophysiology Conventionaltreatment Advancedtherapy Venousulcers Clinicalcases Search Welcome Acknowledgements Contact ElenaCondeMontero Allpublications Generalconcepts Typesofwoundsandpathophysiology Conventionaltreatment Advancedtherapy Venousulcers Clinicalcases HomeVenousulcersCEAPClassificationofChronicVenousDisorders:Let’sallspeakthesamelanguage. TheCEAPclassification(Clinical-Etiological-Anatomical-Pathophysiological)wascreatedin1994tostandardizethediversemanifestationsofchronicvenousdisease.Itwasmodifiedin2004torefermorebroadlytochronicvenousdisorders.Therefore,itcoversthebroadspectrumofmorphologicalandfunctionalalterationsofthevenoussystem. Itisinterestingtodifferentiatetheseterms,whichhavebeendefinedbyinternationalconsensus:  Chronicvenousdisorders:itincludesthewholespectrumofmorphologicalandfunctionalanomaliesofthevenoussystem.  Chronicvenousdisease:usedwhenthemorphologicalorfunctionalalterations(valvularincompetence)arepresentoflongdurationandmanifestedwithsignsandsymptomsthatneedtobestudiedandtreated.Valvularincompetenceisidentifiedwithduplexultrasoundasaretrogradevenousflowofprolongedduration.Symptomsincludepain,burning,itching,heaviness,fatigue,musclecramps.Signsincludedilatedveins(telangiectasias,varicoseveins),oedema,skinalterationsandulceration.Theseverityofsignsandsymptomsdoesnotalwayscorrelatewiththedegreeofunderlyingvalvedysfunction.  Chronicvenousinsufficiency:usedforpatientswithchronicvenousdiseasewhopresentclinicalsignsofgreaterinvolvement,suchassignificantoedema,skinchanges,orulceration.   Asitsnameindicates,theCEAPclassificationiscomposedof4sub-classifications: C:Clinical  E:Etiological A:Anatomical P:Pathophysiological     C(Clinical):Weoftenuseitinisolation. C0:novisibleorpalpablesigns C1:telangiectasias(veinslessthan<1mm),reticularveins(1-3mmindiameter) C2:varicoseveins(>3mm) C3:oedema C4:secondaryskinalterations C4a:pigmentation,eczema,orboth Pigmentationisabrown-greyishcolorationoftheskinduetohemosiderindepositionbyextravasationofredbloodcells.Itusuallyoccursintheankle,butcanaffectthefootandrestoftheleg. Eczemaisanerythematousanddesquamativedermatitis,whichcandevelopvesiclesandexudate. C4b:lipodermatosclerosis,whiteatrophy,orboth Lipodermatosclerosisistheresultofoedemaandchronicinflammation,withconsequentthickeningandfibrosisoftheskinandsubcutaneouscellulartissue. Whiteatrophy(Atrophieblanche)isacircularorstarredareaofscar-likeappearance,depressed,withpearly-whitecoloration,surroundedbydilatedcapillariesandhyperpigmentation. C5:healedulcer C6:openulcer(oftenintheanklearea TheCclassificationiscompletedwiththepresenceorabsenceofsymptoms(pain,itching,heavylegs,cramps,others): A:asymptomatic B:symptomatic   E(Etiological) Ep: primary(developsindependentlyofotherdiseases) Ec: congenital(presentatbirthordevelopingininfancy) Es: secondary,ifitappearsasaconsequenceofanotherdisorder,suchastraumaorthrombosis(post-thromboticsyndrome) En:absenceofidentifiedvenousaetiology   A(Anatomical):Thevenoussystemconsistsofasuperficialvenoussystemandadeepvenoussystem.Theveinsthatjoinvesselswithinthesamesystemarecalledcommunicatingveins,whilethosethatconnectthesuperficialtothedeeponesarecalledperforatingveins.Inordertoidentifytheexactlocationofthevenousanomaly,thevenoussystemhasbeendividedinto18anatomicalsegmentswithinthegeneralclassificationofsuperficial(As),deep(AD)andperforating(AP)veins.Sometimestheaffectedsegment(An)cannotbedetermined. Ifyouwanttoknowmoreabouttheanatomyofthevenoussystemofthelowerlimb:MeissnerMH(2005)Lowerextremityvenousanatomy. AS1-5: superficialvenoussystem As1:telangiectasiasorreticularveins As2:greatsaphenousveinabovetheknee As3:greatsaphenousveinbelowtheknee As4:smallsaphenousvein As5:non-saphenousvein AD6-16: deepvenoussystem(D=Deep) AD6:inferiorvenacava AD7:commoniliacvein AD8:internaliliacvein AD9:externaliliacvein AD10:pelvic AD11:commonfemoralvein AD12:deepfemoralvein AD13: femoralvein AD14:poplitealvein AD15: anteriortibial,posteriortibial,peronealveins AD16:muscular(gastrocnemius,soleus) Ap17-18:perforatingveins Ap17:thigh Ap18:twin An: unidentifiedanatomicallocation   P(Pathophysiology):indicatesthepresenceofvenousrefluxorobstruction. Thevenousbloodflowisdeterminedbythedrainagefromthesuperficialtothedeepsystem,thankstothemuscularcontractionthatovercomesgravity,andtothepreventionofitsrefluxbytheclosingofthevenousvalves. PR:Reflux Valvularalterations,congenitalorsecondary(trauma,thrombosis),canproducedifferentdegreesofretrogradeflow(abnormalifitlastsmorethan0.5seconds,detectedbyduplexultrasound).Deeprefluxisusuallyassociatedwithmoresevereclinicalsymptoms.However,ulceroccurrencewithisolatedsuperficialvenousrefluxisalsopossible. PO:Obstruction Superficialanddeepvenousthrombosiscauseanobstructionthathindersvenousflow.Consequently,superficialveinsbecometortuousandalternativedrainageroutesaredeveloped.Althoughthethrombusmaybepartiallyortotallyreabsorbed,damagetothewallsegmentandvalvesispermanent. PR,O:reflux/obstruction Pn:unidentifiedvenouspathophysiology     References: EklöfB,RutherfordRB,BerganJJ,CarpentierPH,GloviczkiP,KistnerRL,MeissnerMH,MonetaGL,MyersK,PadbergFT,PerrinM,RuckleyCV,SmithPC,WakefieldTW.RevisionoftheCEAPclassificationforchronicvenousdisorders:consensusstatement.JVascSurg.2004;40(6):1248 EklofB,PerrinM,DelisKT,RutherfordRB,GloviczkiP.Updatedterminologyofchronicvenousdisorders:theVEIN-TERMtransatlanticinterdisciplinaryconsensusdocument.JVascSurg.2009;49(2):498 MonetaG.Classificationoflowerextremitychronicvenousdisorders.UpToDate,lastupdatedaugust2014 MeissnerMH(2005)Lowerextremityvenousanatomy.SeminInterventRadiol.2005;22:147–156.   Alsoavailablein: Español(Spanish) RELATEDARTICLESMOREFROMAUTHOR Theimportanceoffootfallandfootwearinvenousulcers HowlongcanIspaceoutdressingchangesofalegulcer? Whyanimalsdonotdevelopvenousulcers? 2COMMENTS Elena, Hi, IamaPhysicaltherapistactiveinwoundcare.IspeakregularlyintheUS.IamgivingatalkontheCEAPclassificationanditsrealtionshiptolymphedema. Idoloveyourpicutres.IamwonderingifIcouldusesomeofthemforatalk.Whatistheprocesstodoso? Reply DearMarta, Thankyouforyourmessage!Ofcourse,youcanuseanypicturesyoumayneed:) Reply LEAVEAREPLYCancelreply Pleaseenteryourcomment! Pleaseenteryournamehere Youhaveenteredanincorrectemailaddress! Pleaseenteryouremailaddresshere Savemyname,email,andwebsiteinthisbrowserforthenexttimeIcomment. Search SocialMedia ElenaCondeenResearchGate Tweetsporel@ElenaCondeMon. Últimosartículos ShouldwoundsALWAYSbecleansed ElenaCondeMontero-27July,20210 Donotdebridedryescharsonheels ElenaCondeMontero-27July,20210 Keratinocytesandtheiranalgesiceffect ElenaCondeMontero-27July,20210 Emollientsforeczemaonlegs ElenaCondeMontero-27July,20210 Eczemacraquelé:whenskindeteriorateslikepaintings ElenaCondeMontero-27July,20210 RecentCommentsblog3008onDistractionasanalgesicstrategyduringdressingchangesElenaCondeMonteroonCEAPClassificationofChronicVenousDisorders:Let’sallspeakthesamelanguage.martaostleronCEAPClassificationofChronicVenousDisorders:Let’sallspeakthesamelanguage. AcademicarticlesAssociationofautologouspunchgrafting,TLC-NOSFdressingandmultitypecompressiontherapytorapidlyachievewoundclosureinhard-to-healvenouslegulcersCONCLUSIONS:Theevaluatedprocedureinducedfastre-epithelisationofthetreatedulcers.Basedonourexperience,thissimpleandsuccessfulreparativestrategymaybeconsideredasaninterestingoptioninthetreatmentofvenouslegulcersofpoorprognosis.EConde-MonteroEarlyandSequentialPunchGraftingintheSpectrumofArteriolopathyUlcersintheElderlyCONCLUSIONS:EarlypunchgraftingisaneffectivetechniqueforpaincontrolandhealingpromotioninMartorellulcers.Punchgrafting,whichmaybeperformedinanoutpatientsetting,iswelltoleratedbypatientsandmayberepeatedseveraltimesifnecessary.ElenaConde-MonteroValidationoftheSpanishWound-QoLQuestionnaireCONCLUSIONS:TheSpanishversionoftheWound-QoLshowsgoodvalidityinclinicalpractice.Itcanberecommendedforuseinclinicalroutineandtrials.ECondeMonteroTheoryandPracticeofCompressionTherapyforTreatingandPreventingVenousUlcersCompressiontherapyisthebasisfortreatingthecauseofvenousulcersandpreventingrecurrence.Varioussystemsarecurrentlyavailableforapplyingcompressionandadaptingthemtopatients'needscanimproveadherencetotreatment.Understandingtheprinciplesthatunderliecompressiontherapyisessentialforsuccess.Althoughthispaperfocusesmainlyonvenousulcers,compressionhas[…]ECondeMonteroBayesianRegressionModelforaCost-UtilityandCost-EffectivenessAnalysisComparingPunchGraftingVersusUsualCarefortheTreatmentofChronicWoundsPunchgraftingisatraditionaltechniqueusedtopromoteepithelializationofhard-to-healwounds.Themainpurposeofthisobservationalstudywastoconductacost-utilityanalysis(CUA)andacost-effectivenessanalysis(CEA)comparingpunchgrafting(n=46)withusualcare(n=34)forthetreatmentofchronicwoundsinanoutpatientspecializedwound[…]CarmenSelva-Sevilla RecentPosts ShouldwoundsALWAYSbecleansed Donotdebridedryescharsonheels Keratinocytesandtheiranalgesiceffect Emollientsforeczemaonlegs Eczemacraquelé:whenskindeteriorateslikepaintings ELENACONDE@PUBMEDAssociationofautologouspunchgrafting,TLC-NOSFdressingandmultitypecompressiontherapytorapidlyachievewoundclosureinhard-to-healvenouslegulcers29November,2020CONCLUSIONS:Theevaluatedprocedureinducedfastre-epithelisationofthetreatedulcers.Basedonourexperience,thissimpleandsuccessfulreparativestrategymaybeconsideredasaninterestingoptioninthetreatmentofvenouslegulcersofpoorprognosis.EConde-MonteroEarlyandSequentialPunchGraftingintheSpectrumofArteriolopathyUlcersintheElderly9November,2020CONCLUSIONS:EarlypunchgraftingisaneffectivetechniqueforpaincontrolandhealingpromotioninMartorellulcers.Punchgrafting,whichmaybeperformedinanoutpatientsetting,iswelltoleratedbypatientsandmayberepeatedseveraltimesifnecessary.ElenaConde-MonteroValidationoftheSpanishWound-QoLQuestionnaire2November,2020CONCLUSIONS:TheSpanishversionoftheWound-QoLshowsgoodvalidityinclinicalpractice.Itcanberecommendedforuseinclinicalroutineandtrials.ECondeMonteroTheoryandPracticeofCompressionTherapyforTreatingandPreventingVenousUlcers24June,2020Compressiontherapyisthebasisfortreatingthecauseofvenousulcersandpreventingrecurrence.Varioussystemsarecurrentlyavailableforapplyingcompressionandadaptingthemtopatients'needscanimproveadherencetotreatment.Understandingtheprinciplesthatunderliecompressiontherapyisessentialforsuccess.Althoughthispaperfocusesmainlyonvenousulcers,compressionhas[…]ECondeMonteroBayesianRegressionModelforaCost-UtilityandCost-EffectivenessAnalysisComparingPunchGraftingVersusUsualCarefortheTreatmentofChronicWounds3June,2020Punchgraftingisatraditionaltechniqueusedtopromoteepithelializationofhard-to-healwounds.Themainpurposeofthisobservationalstudywastoconductacost-utilityanalysis(CUA)andacost-effectivenessanalysis(CEA)comparingpunchgrafting(n=46)withusualcare(n=34)forthetreatmentofchronicwoundsinanoutpatientspecializedwound[…]CarmenSelva-SevillaPunchgraftingforpainreductioninhard-to-healulcers12March,2020CONCLUSION:Punch-graftingisasimple,techniquethatnotonlypromoteswoundhealingbutalsoreducespain.Itcanalsobeperformedonanoutpatientbasis.Furtherstudiesshouldbeperformedtoachieveabetterunderstandingofthisbeneficialfinding.Declarationofinterest:Theauthorshavenoconflictsofinteresttodeclare.ElenaConde-MonteroRefractorypalmoplantarpustulosissuccesfullytreatedwithapremilast26January,2020Palmoplantarpustulosisisachronicinflammatorydiseasewhichcharacterizedbyaeruptionofsterilepustulesonthepalmsandsoles.Apremilastisanoralphosphodiesterase-4inhibitorwhichisapprovedforthetreatmentofchronicplaquepsoriasisandpsoriaticarthritis.However,noclinicaltrialhasbeenperformedtoconfirmtheefficacyofapremilastforpalmoplantarpustulosis[…]RaquelCarrascosadeLomeClinicallyinactivepyodermagangrenosumsuccessfullytreatedwithnegativepressuretherapyandpunchgrafting4January,2020NoabstractRaquelGradoSanzUlcerativenecrobiosislipoidicadiabeticorumsuccessfullytreatedwithtopicalsevofluraneandpunchgrafting15August,2019NoabstractLucíaQuintana-CastanedoEfficacyandsafetyofarosehipseedoilextractinthepreventionandtreatmentofskinlesionsinthehandsofpatientswithtype1diabetesmellituscausedbyfingerprickbloodglucosemonitoring;arandomized,open-label,controlledclinicaltrial26June,2019CONCLUSION:Ahighprevalenceofskinlesionssecondarytofingerprickglucosemonitoring,mostofthemmildlesions,wasfoundatstudystart.Treatmentwithrosehipseedoilwassafeandwasnoteffectiveforimprovingskinlesions.AnaBelénAguirre-Romero Categories Advancedtherapy Clinicalcases Clinicalcases Conventionaltreatment Featured Generalconcepts pearls Scientificmeetings Typesofwoundsandpathophysiology Uncategorized Venousulcers Contacto ¿Tienesunaherida? ©Copyright2020-ElenaCondeMontero English Español(Spanish) #td_uid_4_59e4e3d3aa25f.entry-title.td-module-title{background-color:#000000!important;} .td-post-category{background-color:#69C4B5!important;} .td-module-meta-info {background-color:#69C4B5!important;} .bottomcontainerBox{display:none;} .entry-date.updated.td-module-date{color:#ffffff!important;}