Venous Disease Is Complex, But It Can Be Described
The first attempts to classify chronic venous disorders focused solely on clinical appearance and led to a lack of diagnostic precision and inability to reproduce treatment results.
The CEAP classification consensus document was written by the American Venous Forum in 1994 to provide a comprehensive objective classification. It was universally accepted and endorsed, with most published papers now using all or portions of the CEAP system. It was comprised of two parts: classification and severity scoring.
C – clinical manifestation
E – etiologic factors
A – anatomic distribution
P – pathophysiologic dysfunction
- Number of anatomic segments affected
- Grading of signs and symptoms
As a result of now meaningful scientific communication of venous disease, improvements in diagnosis and treatment followed. This naturally led to the need to update and refine CEAP. Based on international consensus recommendations the AVF published a revised CEAP document in 2004.
Venous Severity Scoring
The VSS (Venous Severity Score) was designed to complement, not replace CEAP
The original CEAP document Clinical Score grading was limited by several factors, and never found widespread support, but it was recognized that a severity scoring system based on CEAP was desirable. In 2000 the AVF developed the three-part Venous Severity Score: Venous Clinical Severity Score (VCSS), Venous Segmental Disease Score (VSDS), and Venous Disability Score (VDS) – a modification of the original CEAP disability score. It has been reported in literature to be “easy and useful both in research and in the daily practice.”
VCSS (Venous Clinical Severity Score)
Based on the clinical elements of CEAP, it utilized the progressive ranking of severity, while weighting the upper levels representing the more severe presentations of CVD. Clinical descriptors with the ability to change over a period of months are graded from 0-3, which allows for improvement to be captured.
The AVF recognized, as it did with CEAP, that refinements were necessary to clarify ambiguities, simplify application and update terminology, resulting in a dynamic and valuable tool for venous medical practitioners. The revised VCSS score was published in 2010 and is currently being evaluated in studies for its validity and reliability.
VSDS (Venous Segmental Disease Score)
Combining the anatomic & pathophysiologic components, major venous segments are graded according to presence of reflux and/or obstruction based entirely on venous imaging studies. The duplex scan results generate a grade which reflects the severity of disease.
Venous Disability Score (VDS)
This modification to the original CEAP disability score substitutes prior normal activity level for the patient rather than ability to complete an 8-hour workday.