DIAGNOSIS OF CHRONIC VENOUS DISEASE OF THE LOWER-EXTREMITIES - THE CEAP CLASSIFICATION

Objective: To test a new classification of chronic venous disease (CVD )-based on clinical, etiologic, anatomic, and pathophysiologic data (t he CEAP system)-in a series of patients by using objective tests to es tablish all diagnoses. Material and Methods: The CEAP classification w as applied to 102 extremities in 70 consecutive patients with CVD. Dia gnoses were based on objective testing with continuous-wave Doppler st udies, duplex scanning, plethysmography, venous pressure, and phlebogr aphy, which were applied selectively (the more invasive methods were r eserved for cases of greater severity). Results: Use of this classific ation provided an organized categorization of the key elements of the venous abnormalities in each case and clarified the interrelationships among the clinical manifestations, cause of the process, and anatomic distribution of involvement. For example, in this series of 102 extre mities, 79% had primary venous disease, 18% had secondary disease, and 3% had congenital abnormalities. Ulcers were found in 7% of extremiti es with primary CVD and 44% with secondary CVD. Of the cases with ulce ration, 43% were due to primary incompetence and 57% to postthrombotic disease. Reflux was the pathophysiologic problem in 86% of the total series and in 80% of ulcer cases. Similar relationships can be delinea ted for cases with varicose veins, edema, or skin changes. Study of th e specific facets of the CEAP classification provided precise informat ion about the cause and the effect of venous abnormalities that could be compared with cases in other series. Conclusion: Use of the CEAP cl assification with diagnoses determined by objective testing accurately identifies categories of CVD. The objective data provide a clear desc ription of the abnormalities in each case and may be used for analyses of meaningful relationships between categories of CVD. Adoption of th is objective method of classifying CVD will facilitate interinstitutio nal studies.