ABC of Vascular Disease
The Classification of Venous Disease
Venous disease of the legs can be classified according to the severity, cause, site and specific abnormality using the CEAP classification. Use of such a classification improves the accuracy of the diagnosis and improves communication between specialists. The elements of the CEAP classification are:
For the initial assessment of a patient, the clinical severity is the most important and can be made by simple observation and does not need special tests. There are seven grades of increasing clinical severity:
The majority of patients referred to the vascular surgical clinic have grade 2 disease (simple varicose veins). Recent work done by my team at Good Hope Hospital shows that this large group can be sub-divided on the basis of a simple non-invasive test called photoplethysmography (PPG).
Patients with C3-6 disease are demonstrating and
increasing severity of chronic venous insufficiency, and all have a functional
abnormality of the venous system. These patients are most at risk of
chronic ulceration and require specialised tests such as venous duplex
and ambulatory venous pressure measurement to diagnose and characterise
the underlying venous abnormality.
Recommendations for new patients with venous disease
© S.R.Dodds 2001