Results of a Questionnaire Regarding Improvement of ‘C’ in the CEAP Classification

Antignani, Pier-Luigi; Cornu‐Thénard, A.; Allegra, Claudio; Carpentier, Patrick; Partsch, Hugo; Uhl, Jean-François

doi:10.1016/j.ejvs.2004.04.001

Cited by 11 publications

(7 citation statements)

References 7 publications

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“…They concluded from 206 responders that future work would be required on discriminating between C 1 and C 2 varicose vein sizes and which C (C 1-3 ) to assign for corona phlebectatica. 5,6 Discrepancies on the C placement of varicose veins of differing sizes were also apparent in an interobserver reproducibility study between 3 clinicians on 54 limbs. 7 In that study there was disagreement between C 0 and C 2 or C 1 and C 2 in 13 legs (24%) but only in 6 legs (11%) between C 2 and C 4 or C 3 and C 4 .…”

Section: Introductionmentioning

confidence: 95%

“…7 In that study there was disagreement between C 0 and C 2 or C 1 and C 2 in 13 legs (24%) but only in 6 legs (11%) between C 2 and C 4 or C 3 and C 4 . The above studies [5][6][7] suggest that further clarification should focus on the definitions of C 0-3 rather than the later stages. Furthermore, it has been commented in an international consensus from experts that patients with more advanced venous disease were most reliably classified.…”

Section: Introductionmentioning

confidence: 99%

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An international survey on the interpretation of pigmentation using the C class of the Clinical, Etiological, Anatomical, Pathophysiological Classification

Lattimer

Kalodiki

Azzam

et al. 2013

Veins and Lymphatics

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Skin changes over the gaiter area like pigmentation, lipodermatosclerosis and eczema are a clinical sign of advanced chronic venous disorder. This is documented as C 4 in the Clinical, Etiological, Anatomical, Pathophysio logical (CEAP) classification. The hypothesis was that there is great variability whether skin changes are recorded as early or advanced disease. The aim was to evaluate different patterns of skin changes by delegates at 3 international venous conferences. Seven high-definition, A4-sized, color photographs were taken of untreated legs with skin changes from patients attending a public hospital venous clinic. They all had venous disease confirmed on duplex with deep or superficial vein reflux >0.5 s. The photographs were displayed and a questionnaire was provided. Delegates familiar with CEAP were asked to choose from 3 C class options for each photograph. The responses were summarized by grouping them into mild (C 0-3 ) and severe (C 4-6 ). A total of 117 delegates completed the questionnaire from 30 countries. A percentage of 60 had practiced phlebology >10 years. The percentages of responders scoring mild (C 0-3 ) and severe disease (C 4-6 ) were: mild/severe=3/96 (photo 1), 65/33 (photo 2), 31/67 (photo 3), 56/34 (photo 4), 74/21 (photo 5), 89/10 (photo 6) and 37/59 (photo 7). The median percentage measure of agreement was 36.8 [95% confidence interval (CI): 24.8-48.9]. The range was 23.2 (95% CI: 10.5-36.0) to 94.8 (95% CI: 90.7-98.9), P<0.001/image, Fisher exact test). This indicates a significant difference of opinion between the appearances of mild and severe clinical disease. Clinical decisions using the C class as a sign of advanced disease may be unreliable if used alone for recording severity, grouping patients or rationing treatment.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

An international survey on the interpretation of pigmentation using the C class of the Clinical, Etiological, Anatomical, Pathophysiological Classification

Lattimer

Kalodiki

Azzam

et al. 2013

Veins and Lymphatics

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“…From the beginning the lack of clear definitions of the clinical signs and symptoms of CVD was criticized. Antignani et al 4 sent a questionnaire concerning the clinical part of the CEAP classification to phlebologists worldwide which was answered by 206 colleagues form 67 countries As a result there were a wide variety of opinions returned, thus demonstrating that the same term was used with various meanings by different physicians. It was also criticized on the grounds that there is a lack of vascular history, no varicose vein score and corona phlebectatica was not included in the classi-fication.…”

Section: Early Criticism Of the Ceap Classificationmentioning

confidence: 99%

Clinical, Aetiological, Anatomical and Pathological Classification (Ceap): Gold Standard and Limits

2012

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The first CEAP (clinical, aetiological, anatomical and pathological elements) consensus document was published after a consensus conference of the American Venous Forum, held at the sixth annual meeting of the AVF in February 1994 in Maui, Hawaii. In the following years the CEAP classification was published in many international journals and books which has led to widespread international use of the CEAP classification since 1995. The aim of this paper is to review the benefits and limits of CEAP from the available literature. In an actual Medline analysis with the keywords 'CEAP' and 'venous insufficiency', 266 publications using the CEAP classification in venous diseases are available. The CEAP classification was accepted in the venous community and used in scientific publications, but in most of the cases only the clinical classification was used. Limitations of the first version including a lack of clear definition of clinical signs led to a revised version. The CEAP classification is the gold standard of classification of chronic venous disorders today. Nevertheless for proper use some facts have to be taken into account: the CEAP classification is not a severity classification, C2 summarizes all kinds of varicose veins, in C3 it may be difficult to separate venous and other reasons for oedema, and corona phlebectatica is not included in the classification. Further revisions of the CEAP classification may help to overcome the still-existing deficits.

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“…With time management of venous diseases has progressed, and many new modalities have been introduced which became popular in many fields. Over the years, criticisms of the instrument have included a lack of precise definitions resulting in a lack of reproducibility in assigning patients to specific clinical classes [15,16]. In the 16 years since the last revision, an enhanced understanding of aspects of venous disease has identified gaps in the ability of CEAP to separately group patients with unique clinical attributes [17].…”

Section: Ceap Classification-creationmentioning

confidence: 99%

Clinical Presentation of Varicose Veins

Ghosh

Mamun²,

Majumder

2021

Indian J Surg

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Varicose vein is one type of venous insufficiency that presents with any dilated, elongated, or tortuous veins caused by permanent loss of its valvular efficiency. Destruction of venous valves in the axial veins results in venous hypertension, reflux, and total dilatation, causing varicosities and transudation of fluid into subcutaneous tissue. The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens. Evidence of surgical intervention was found in the 1860s. However dramatic advances of varicose vein management occurred in the latter half of twentieth century. Varicose veins affect from 40 to 60% of women and 15 to 30% men. Multiple intrinsic and extrinsic factors including age, gender, pregnancy, weight, height, race, diet, bowel habits, occupation, posture, previous DVT, genetics, and climate are considered to be the predisposing factors for formation of varicose vein. Other reported factors are hereditary, standing occupation, chair sitting, tight underclothes, raised toilet seats, lack of exercise, smoking, and oral contraceptives. Common symptoms are unsightly visible veins, pain, aching, swelling, itching, skin changes, ulceration, thrombophlebitis, and bleeding. The signs of varicose vein disease are edema, varicose eczema or thrombophlebitis, ulcers (typically found over the medial malleolus), hemosiderin skin staining, lipodermatosclerosis (tapering of legs above ankles, an “inverted champagne bottle” appearance), and atrophie blanche. Varicose vein is classified according to CEAP classification, the components of which are clinical, etiological, anatomy, and pathophysiology. The revised CEAP classification was published on 2020 based on four principles which were preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based medicine, and practicality.

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Results of a Questionnaire Regarding Improvement of ‘C’ in the CEAP Classification

Abstract: Further clarification and refinement of the CEAP classification are necessary. The authors hope that this will result in broader acceptance of CEAP.

Cited by 11 publications

References 7 publications

An international survey on the interpretation of pigmentation using the C class of the Clinical, Etiological, Anatomical, Pathophysiological Classification

An international survey on the interpretation of pigmentation using the C class of the Clinical, Etiological, Anatomical, Pathophysiological Classification

Clinical, Aetiological, Anatomical and Pathological Classification (Ceap): Gold Standard and Limits

Clinical Presentation of Varicose Veins

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