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2020 update to CEAP classification system and reporting ...

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A 2020 update on the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system and reporting standards, authored by Fedor Lurie ... Home LatestNews Features VascularNews Profiles Media Videos Podcasts Events Supplements PastIssues Subscriptions Search VenousNews Home LatestNews Features VascularNews Profiles Media Videos Podcasts Events Supplements PastIssues Subscriptions LatestNews FedorLurie A2020updateontheClinical-Etiology-Anatomy-Pathophysiology(CEAP)classificationsystemandreportingstandards,authoredbyFedorLurie(JobstVascularInstitute,Toledo,USA;UniversityofMichigan,AnnArbor,USA)andcolleagues,hasbeenpublishedintheJournalVascularSurgery:VenousandLymphaticDisorders. LurieetalbeginbydescribingtheCEAPclassificationasaninternationallyacceptedstandardfordescribingpatientswithchronicvenousdisordersandexplainthatithasbeenusedforreportingclinicalresearchfindingsinscientificjournals. Theyelaborate:“Developedin1993,updatedin1996,andrevisedin2004,CEAPisaclassificationsystembasedonclinicalmanifestationsofchronicvenousdisorders,oncurrentunderstandingoftheetiology,theinvolvedanatomy,andtheunderlyingvenouspathology.” Theauthorsexplainthat,astheevidencerelatedtotheseaspectsofvenousdisorders,andspecificallyofchronicvenousdiseases(CVD,C2–C6)continuetodevelop,theCEAPclassificationneedsperiodicanalysisandrevisions. InMay2017,theAmericanVenousForum(AVF)createdaCEAPTaskForceandchargedittocriticallyanalysisthecurrentclassificationsystemandrecommendedrevisionswhereneeded. Guidedbyfourbasicprinciples—preservationofthereproducibilityofCEAP,compatibilitywithpriorversions,evidence-based,andpracticalguidanceforclinicaluse—theTaskForcehasadoptedtherevisedDelphiprocessandmadeseveralchanges. TheseincludeaddingCoronaphlebectaticaastheC4cclinicalsubclass,introducingthemodifier“r”forrecurrentvaricoseveinsandrecurrentvenousulcers,andreplacingnumericdescriptionsofthevenoussegmentsbytheircommonabbreviations. Theauthorsnotethat,sinceitsinitialdevelopment,theCEAPclassificationhasbeenandcontinuestobe“animportantcontributortoprogressinthefieldofCVD.Ithasbecomeauniversallyacceptedstandardinresearchandreporting.” Althoughthestabilityofclassificationis“essential”formaintainingscientificandclinicaladvancement,“continuouslyaccumulatedevidenceandknowledgerequirerevisitingtheclassificationanditsdefinitionsandrevisingthemwhennecessary,”theyremark. Lurieetalconclude:“This2020CEAPrevisionisaresultofarigorousprocessofevidenceanalysis.Althoughseveralproposedchangeswerenotincludedinthefinalversion,proponentsoftheseandotherfuturepotentialrevisionsareencouragedtodevelopandpublishsupportingevidence.Whensuchevidenceisavailable,theAVFTaskForcewillrevisittheCEAPclassificationsystem,makingrevisionsaspartofacontinualprocessandmaintainingtheintegrityofCEAPastheuniversallyacceptedclassificationsystemandreportingstandardforCVD.” Inanaccompanyingeditorial,BoEklöf(LundUniversity,Helsingborg,Sweden)laudsthe“timelyandwarranted”revisionofthe25-yearoldCEAPclassification,notingthat“reliancefortoolongwasplacedontheclinicalappearanceofthelimbandthesuperficialveins,withoutrequiringobjectivetestingofthevenoussystemtosubstantiatethediagnosis.” Heelaborates:“PreviousclassificationsfromWidmer(1978)throughMiranda(1993)lackedcompletenessandobjectivityneededforscientificaccuracy.” Focusingonthe2020update,Eklöfcomments:“TheAVFTaskForce,undertheleadershipinFedorLurieandMarkPassman[UniversityofAlabamaatBirmingham,Birmingham,USA],hasdoneanexcellentjobwiththelatest,secondrevisionandwithexplanationoftheimportantroleofCEAPinCVD.” “PublicationofthedocumentappearstobeagoodreasontoremindreviewersandeditorstorequirethecompleteCEAP—basicoradvanced—classificationformanuscriptsdealingwithCVDtoimprovethescientificqualityofpublishedliterature.Bybothadheringtotheseprinciples,wemaybebackwherewewere40yearsago,usingWidmer’sclinicalclassification.”Previouslyintheeditorial,EklöfremarksthatWidmer’sclassification(1978)“lackedcompletenessandobjectivityneededforscientificaccuracy”. 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