Venous severity scoring: An adjunct to venous outcome assessment

Some measure of disease severity is needed to properly compare the outcomes of the various approaches to the treatment of chronic venous insufficiency . Comparing the outcomes of two or more different treatments in a clinical trial, or the same treatment in two or more reports from the literature can not be done with confidence unless the relative severity of the venous dise ase in each treatment group is known. The CEAP (Clinical-Etiology-Anatomic- Pathophysiologic) system is an excellent classification scheme, but it cann ot serve the purpose of venous severity scoring because many of its compone nts are relatively static and others use detailed alphabetical designations . A disease severity scoring scheme needs to be quantifiable, with gradable elements that can change in response to treatment. However, an American Ve nous Forum committee on venous outcomes assessment has developed a venous s everity scoring system based on the best usable elements of the CEAP system . Two scores are proposed. The first is a Venous Clinical Severity Score: n ine clinical characteristics of chronic venous disease are graded from 0 to 3 (absent, mild, moderate, severe) with specific criteria to avoid overlap or arbitrary scoring. Zero to three points are added for differences in ba ckground conservative therapy (compression and elevation) to produce a 30 p oint-maximum flat scale. The second is a Venous Segmental Disease Score, wh ich combines the Anatomic and Pathophysiologic components of CEAP. Major ve nous segments are graded according to presence of reflux and/or obstruction . Ir is entirely based on venous imaging, primarily duplex scan but also ph lebographic findings. This scoring scheme weights 11 venous segments for th eir relative importance when involved with reflux and/or obstruction, with a maximum score of 10. A third score is simply a modification of the existi ng CEAP disability score that eliminates reference to work and an 8-hour wo rking day, substituting instead the patient's prior normal activities. Thes e new scoring schemes are intended to complement the current CEAP system.