Before the mid-1990s, venous disorders and disease were classified almost solely on clinical appearance, which failed to achieve diagnostic precision or reproducible treatment results. In response to this, the American Venous Forum developed a classification system in 1994, which was revised in 2004. This classification system has gained widespread acceptance across the clinical and medical research communities, and most published papers now use all or part of the CEAP system (defined in the next section).1 This system was once again updated in 2020.2 These guidelines have value in their ability to provide consistency in the treatment of patients, which also results in greater efficacy, improved quality of care, and reduced cost.
Venous leg ulcers often involve a high level of costly care and can consume many medical resources, resulting in the need for specific guidelines to maximize the quality and effectiveness of care while also minimizing cost and resources used during the course of treatment.3
The basic CEAP system consists of two parts: classification and severity. Classification has four components: clinical manifestation, etiologic factors, anatomic distribution, and pathophysiologic dysfunction. Severity has four components: the number of anatomic segments affected, the grading of signs and symptoms, and disability.1 The original CEAP classification system appeared as follows2:
In addition to the CEAP classification, the Venous Clinical Severity Score (VCSS) was introduced in 2000 and revised in 2010 as a complement to the CEAP system. This system includes 10 clinical descriptors, scored from 0 to 3 with 0 indicating no presence and 3 indicating severe presence. The VCSS can have a score that totals between 0 and 30 to provide physicians with a method for assessing changes to therapy. This system includes the following descriptors4:
In addition to the VCSS, the Advanced CEAP classification system includes 18 named venous segments that can be used as locators for venous disease. These names include5:
The accurate classification of venous disease is critical in understanding venous disease severity and the assessment of treatment efficacy. The CEAP classification system and the VCSS can be used to follow clinically defined changes over time. When using these systems, there are several things to keep in mind2:
Classification systems, and particularly CEAP for venous leg ulcers, can provide a solid foundation for understanding a patient's unique ulcer characteristics. When used correctly, these tools can be incredibly helpful in identifying and selecting the most appropriate treatment course.
1. American Venous Forum. CEAP & Venous Severity Scoring. https://www.veinforum.org/medical-allied-health-professionals/avf-initi…. Accessed December 19, 2019.
2. Venous News. (2020, March). Revision of CEAP classification recognises new predictors and definitions for venous disease. 2020. https://venousnews.com/revision-ceap-classification-venous-disease-avf-…. Accessed March 27, 2020.
3. O'Donnell TF, Passman MA, Marston WA, et al. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2014;60(2):3S-59S.
4. American Venous Forum. Revised Venous Severity Score. https://www.veinforum.org/wp-content/uploads/2019/05/Revised-VCSS-AVF.p…. Accessed December 19, 2019.
5. American Venous Forum. Revision of the CEAP Classification: Summary. https://www.veinforum.org/wp-content/uploads/2018/03/Revised-CEAP-Class…. Accessed December 19, 2019.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.