CEAP classification of severity of varicose veins - The ...

The C or clinical score from the CEAP classification ranges from C0 which means absolutely no venous disease that can be seen or felt in the legs to C6 ... CEAPclassificationoftheseverityofvaricoseveins by ProfessorMarkWhiteleyMSFRCS(Gen)FCPhleb CEAPMenu Bookaconsultation Procedures CallUs! Prices Locations Tweetsby@whiteleyclinic CEAPclinicalscore TheCorclinicalscorefromtheCEAPclassificationrangesfromC0whichmeansabsolutelynovenousdiseasethatcanbeseenorfeltinthelegstoC6whichmeansanopenandactivevenouslegulcer. However,wheneverusingtheCEAPclinicalscore,itisessentialtorememberthatitisonlyaclinicalscore.Itisquitepossiblethatifavenousduplexultrasoundscanisperformed(whichshouldalwaysbethecasewhenassessinganyvenousdisease)thenmoreoftenthannot,worsevenousdiseasesarefounddeeperinsidethelegthatcannotbeseenbyclinicalexaminationalone. Hencenodoctorornursewhoknowsanythingaboutvaricoseveinsorveinproblemswillevergiveafullopinionontheclinicalgradingalone.Withouthavingavenousduplexultrasoundscanperformedbyaspecialistvascularscientist,whocanexaminealloftheveinsinthelegsandpelvistolookforunderlyingvenousdisease,afulldiagnosiscannotbegiven. Thefullclassificationcanbeseeninthetablebelow. PleaseclickontherelevantCEAPClinicalclassificationtobetakentotherelevantpage. CEAPClinicalScore Description C0 Novisibleorpalpablevaricoseveins C1 Telangectasia(Threadveins/Spiderveins/Brokenveins) C2 C2A Varicoseveinswithoutanysymptoms(Asymptomatic) C2S Varicoseveinswithsymptoms C3 Swollenankle(oedema)duetovaricoseveinsorhiddenvaricoseveins(venousreflux) C4 Skindamageduetovaricoseveinsorhiddenvaricoseveins(venousreflux) C5 Healedvenouslegulcer C6 Venouslegulcer CEAPClinicalScore Description C0 Novisibleorpalpablevaricoseveins C1 Telangectasia(Threadveins/Spiderveins/Brokenveins) C2 Varicoseveins C2A Varicoseveinswithoutanysymptoms(Asymptomatic) C2S Varicoseveinswithsymptoms C3 Swollenankle(oedema)duetovaricoseveinsorhiddenvaricoseveins(venousreflux) C4 Skindamageduetovaricoseveinsorhiddenvaricoseveins(venousreflux) C5 Healedvenouslegulcer C6 Venouslegulcer CEAPclassificationofvaricoseveinsseverity Althoughmostpeoplewithvaricoseveinswillknowthattheyhavebulgingveinsintheirlegswhentheystandup,whichtendtodisappearwhentheyliedown,itisimportanttohaveagradingsystemtoindicatetheseverityofthevaricoseveinproblem. Initially,agradingforseverityhelpeddoctorscommunicatewitheachother.Forinstance,afamilydoctororgeneralpractitionerreferringapatientwithvaricoseveinstoaveinspecialistneededtobeabletoindicatehowseverethevaricoseveinproblemwas.Thiswouldhelpthespecialistknowwhetherthereferralwasurgentornot. Inaddition,thoseofuswhoareinvolvedwithresearchintovaricoseveinsandvenousdiseasesneedtobeabletoclassifyourpatientsintodifferentgroupsaccordingtotheseverityoftheirvaricoseveinproblem.Forinstance,onedoctororclinicmayclaimexcellentresultswithonetechnique,whereasanotherdoctororclinicmayfindthesametechniquedoesnotworksowellfortheirpatients.Therecanbemanyreasonsforthis,butoneoftheeasiesttomeasureiswhetherbothdoctorsandclinicsareactuallytreatingthesamesortofpatientswiththesameseverityofproblem. Overthelastfewyears,withtheNationalHealthServiceintheUKandhealthinsurancecompaniesintheUK,USAandelsewhereintheworldstartingtocutbackonfundingforvaricoseveintreatments,ithasbecomeimportantforpatientstoknowhowseveretheirveinsare.Thisisbecausethedecisionastowhetherapatientcanhavetheirveinstreatedornotoftencomesdowntotheseverityoftheirvaricoseveinproblem. Therefore,itisessentialthateverybodyusesthesameclassificationsystemtoscoretheseverityofvaricoseveins.Byhavingauniformsystem,patientsanywhereintheworldcanbeassessedastotheirclinicalseverityandthereforedecisionsaboutfunding,researchordifferenttechniquescanbetaken. ThemostwidelyusedclassificationfornotingtheseverityofthevaricoseveinprobleminanindividualpatientiscalledtheCEAPclassification. Cosmeticvaricoseveins,medicalvaricoseveinsandCEAPscore Inthepast,andunfortunatelyeventoday,agreatmanydoctors,nursesandpeopleinthegeneralpublicthinkthatvaricoseveinsare“justcosmetic”. Althoughsomevaricoseveinsarecosmetic,thereisaveryhighproportionofvaricoseveinsandassociatedvenousdiseasethatcausesmedicalproblemsandthereforeis“medical”not“cosmetic”. EversincetheNationalInstituteofHealthandClinicalExcellence(NICE)publisheditsguidelinesonvaricoseveinsinJuly2013,wehavenowbeenabletodivide“cosmeticvaricoseveins”from“medicalvaricoseveins”byusingtheCEAPclinicalscore.Pleaseseebelowforthereference: Reference:NICEclinicalguidelinesforvaricoseveinsJuly2013(CG168) CEAPclassification ThelettersCEAPstandfor: C=clinicalfindings E=etiologicalfactors(Americanspelling!UKspellingwouldbe=aetiologicalfactors) A=anatomicalcause P=pathophysiologicalcause WhentheCEAPclassificationwasfirstdevised,itwasthoughtthateverylegwithvaricoseveinscouldbedescribedandgradedbythesefourfactors.Howeverusingallfourpartsofthesystemmakestheclassificationexceptionallydifficult. ThereforeitisnowveryrareforanyonetousetheEAPpartoftheclassification.Whethertalkingaboutpatientsbetweendoctors,publishingresearchstudiesordecidingwhoshouldgetfundedbyNHSorprivatemedicalinsurance,almosteverybodynowjustusestheC(clinical)classificationfromCEAP. Bookaconsultation Procedures CallUs! Prices Locations