Rl. Kistner et al., DIAGNOSIS OF CHRONIC VENOUS DISEASE OF THE LOWER-EXTREMITIES - THE CEAP CLASSIFICATION, Mayo Clinic proceedings, 71(4), 1996, pp. 338-345
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.