Classification of Venous Diseases

CEAP classification

The elements of the CEAP classification are:

	Clinical severity
	Etiology or cause
	Anatomy
	Pathophysiology

 There are seven grades of increasing clinical severity:

Grade	Description
C 0	No evidence of venous disease.
C 1	Superficial spider veins (reticular veins) only
C 2	Simple varicose veins only
C 3	Ankle oedema of venous origin (not foot oedema)
C 4	Skin pigmentation in the gaiter area (lipodermatosclerosis)
C 5	A healed venous ulcer
C 6	An open venous ulcer

Recommendations for new patients with venous disease

Group	Action
CEAP 1	No need to refer to NHS clinic, cosmetic problem only
CEAP 2	Refer routinely to "Fast Track Varicose Vein Clinic" for photoplethysmography assessment
CEAP 3 - 5	Refer soon to "Fast Track Varicose Vein Clinic" for venous duplex ultrasound assessment
CEAP 6	Refer urgently to "One Stop Leg Ulcer Clinic" for full leg ulcer assessment

Acute Limb Ischaemia (ALI)

 Rutherford's Classification of Peripheral Arterial Disease

Class	Category	Prognosis	Sensory loss	Muscle weakness	Arterial Doppler	Venous Doppler
I	Viable	No immediate limb threat	None	None	Audible	Audible
IIA	Threatened: marginal	Salvageable if treated promptly	Minimal-none	None	+/-Audible	Audible
IIB	Threatened: Immediate	Salvageable if treated immediately	More than just toes	Mild-moderate	Rare audible	Audible
III	Irreversible	Limb loss or permanent damage	Profound	Profound	None	None

-from the Society of Vascular Surgery/International Society of Cardiovascular Surgery (Rutherford et al, 1997)

1.      Usually thrombotic occlusions are class I or IIA and are treated with intra-arterial thrombolysis if symptom duration <14 days (especially if bypass graft occlusion) and if patient has significant co-morbidities/high operative risk.

2.      Usually embolic occlusions are class IIB or III.  They usually require surgery as thrombolytics take effect too slowly.