What's new in the 2020 update of the CEAP classification system of chronic venous disease?

Objective To study the relationship between the static foot disorders (SFDs) and chronic venous disease (CVD). Material and methods A retrospective study of 824 feet in unselected 412 patients seen by one phlebologist using a standardized record form. A complete clinical, aetiological, anatomical and pathological elements (CEAP) classification was determined. Alleged venous symptoms were recorded using a 10-point visual analogue scale and scored using a customized questionnaire. A standardized measurement of the Djian-Annonier angle was used to quantify and identify the presence of any static disorder of the foot. Results There were 156 men (37.8%) and 256 women (62.2%) who were included in this study. A majority of patients (59.3%) had a CEAP classification of C3 or greater. Static disorders of the feet were found to be very common in the study population: 137 feet were hollow feet (16.6%) and 120 flat feet (14.5%). Thus, 31% of all of the feet had some form of SFD. A significant correlation was found between the incidence of SFD and body mass index ( P < 0.01), the presence of symptoms ( P<0.001) and prolonged standing during the day (>5 hours, P < 0.05). The severity of the CVD, represented by the CEAP clinical classes, was also found to be very significantly related to the SFD ( P < 0.001). This correlation was found to be independent of age. Conclusion Static disorders of the foot can be considered as an important risk factor that negatively affects CVD. In daily practice, it is often underestimated. This emphasizes the crucial importance of the detection of SFD during the clinical exam of all CVD patients. Correction of static disorders of the feet will improve symptoms due to the SFD, as well as those related to venous stasis. These results can easily be explained by improvement of foot pump efficacy during walking.

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Plasma levels of leucocyte elastase-generated cross linked fibrin degradation products (E-XDP) are elevated in chronic venous disease

PLoS ONE ◽

10.1371/journal.pone.0261073 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261073

Author(s):

Helen Sinabulya ◽

Angela Silveira ◽

Lena Blomgren ◽

Joy Roy

Keyword(s):

Reference Group ◽

Degradation Products ◽

Chronic Venous Disease ◽

Enzyme Linked Immunosorbent Assay ◽

Venous Disease ◽

Fibrin Degradation Products ◽

Leucocyte Elastase ◽

History Of ◽

Ceap Classification ◽

Independent Association

Patients with chronic venous disease (CVD) have elevated levels of leucocyte elastase (LE) released from the activation of leucocytes. In acute deep venous thrombosis (DVT), LE can degrade fibrin from the thrombus resulting in cross-linked fibrin degradation products (E-XDP) being released into the bloodstream. In patients with CVD the levels and significance of circulating E-XDP are unknown. We aimed to investigate the association between plasma E-XDP concentration and severity of CVD. Levels of E-XDP were quantified with a specific enzyme-linked immunosorbent assay (ELISA) in plasma from 142 consecutively recruited CVD patients (mean age 64 years, (range 23–89), 81 were females and 61 males). Patients were also divided into three groups based on CVD severity using the C-class of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification, with C 0–1 class as the reference group, C 2–3 as the second group and C 4–6 as the third group with the most severely affected patients. We found significantly elevated levels of E-XDP in patients with C 4–6 compared with patients with C 0–1 (p = 0.007) and increased with increasing disease severity across the groups (p = 0.02). Significant independent association was observed between levels of E-XDP and the classes C 4–6 after adjustment for age and sex (p < 0.05), but the association was no longer significant after further adjustment for use of statins, use of anticoagulants and history of DVT (p = 0.247). This exploratory study shows that E-XDP levels are elevated in patients with CVD, encouraging further studies on the role of E-XDP in CVD.

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How specific are venous symptoms for diagnosis of chronic venous disease?

Phlebology The Journal of Venous Disease ◽

10.1177/0268355513515859 ◽

2014 ◽

Vol 29 (9) ◽

pp. 580-586 ◽

Cited By ~ 29

Author(s):

SK Van der Velden ◽

NH Shadid ◽

PJ Nelemans ◽

A Sommer

Keyword(s):

Arterial Disease ◽

Cross Sectional Study ◽

Lower Limbs ◽

Chronic Venous Disease ◽

Venous Disease ◽

Disease Group ◽

Cross Sectional ◽

Ultrasound Findings ◽

Ceap Classification ◽

Peripheral Arterial

Objective The objective of this study is to evaluate whether and which ‘venous’ symptoms are characteristic for patients affected with chronic venous disease compared to patients with other diseases of the lower limbs (e.g. arthrosis, peripheral arterial disease, spinal disc herniation). Methods A cross-sectional study was performed to compare the frequency of venous symptoms among 76 patients with chronic venous disease and reflux and 74 patients with other diseases of the legs without reflux. The VEINES-Sym of the VEINES-QOL/Sym questionnaire was used to evaluate the frequency of symptoms. Demographic, clinical classification and ultrasound findings were also noted. Results A total of 122 patients were included for analysis (response rate of 87%). Presence of venous symptoms was slightly more often reported in the chronic venous disease group than in the non-chronic venous disease group, but differences were small and statistically non-significant. Severity of chronic venous disease as classified by the CEAP classification was not associated with higher proportions of patients reporting symptoms than in non-chronic venous disease patients, except for swelling ( p = .016) and itching ( p = .007) in C3-C6 patients. The largest difference between the chronic venous disease and non-chronic venous disease group was observed for the time of the day at which symptoms were most intense; patients with chronic venous disease were more likely to experience symptoms at the end of the day ( p < .001). Conclusions The small differences in prevalence of reported ‘venous’ symptoms between chronic venous disease patients and patients with other diseases of the legs suggest that these symptoms may be less specific for patients with chronic venous disease and refluxing veins than is usually assumed.

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Correlation between the hemodynamic gain obtained after operation of primary varicose veins and chronic venous disease classification

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000800021 ◽

2011 ◽

Vol 26 (suppl 2) ◽

pp. 115-119 ◽

Cited By ~ 3

Author(s):

Nei Rodrigues Alves Dezotti ◽

Edwaldo Edner Joviliano ◽

Takachi Moriya ◽

Carlos Eli Piccinato

Keyword(s):

Surgical Treatment ◽

Varicose Veins ◽

Disease Classification ◽

Clinical Severity ◽

University Hospital ◽

Chronic Venous Disease ◽

Venous Disease ◽

Severe Group ◽

Primary Varicose Veins ◽

Ceap Classification

CONTEXT: Previous studies have demonstrated improvement of venous hemodynamics after surgical treatment of primary varicose veins of the lower extremities using air plethysmography (APG). PURPOSE: To correlate the venous hemodynamics obtained by APG with the CEAP classification after surgical treatment of primary varicose veins. METHODS: We studied 63 limbs of 39 patients (35 women and 4 men) aged on average 46.3 years, operated upon at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, during the period from January 2001 to December 2004. The 63 limbs were divided into the three following groups according to CEAP classification: group C2 + C3 (38 limbs), group C4 (15 limbs) and group C5 + C6 (10 limbs). The patients were evaluated clinically before and 30 to 40 days after surgery by preoperative duplex ultrasonography and pre- and postoperative APG. RESULTS: There was an apparent hemodynamic improvement after surgical treatment of the varicose veins in the two groups of lower severity, but the improvement was significant in the most severe group based on venous filling index. CONCLUSION : Surgical treatment was beneficial for all three groups, but the greatest hemodynamic gain was observed in the group of highest clinical severity (group C5 + C6).

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Relationships between severity of signs and symptoms and quality of life in patients with chronic venous disease

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.20140039 ◽

2015 ◽

Vol 14 (1) ◽

pp. 22-28 ◽

Cited By ~ 6

Author(s):

Fabio Henrique Rossi ◽

Marília Granzotto Volpato ◽

Patrick Bastos Metzger ◽

Camila Baumann Beteli ◽

Bruno Lourenção de Almeida ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Clinical Severity ◽

Chronic Venous Disease ◽

Venous Disease ◽

Life Questionnaire ◽

Sf 36 ◽

Ceap Classification ◽

Positive Correlations

BACKGROUND: Chronic venous disease (CVD) is progressive and has a high prevalence in the economically active population. Its impact on the quality of life of affected individuals is poorly understood. OBJECTIVE: To test for correlations between the CEAP classification of CVD severity and CVD symptoms and quality of life of affected individuals. METHODS: We investigated 91 lower limbs in 59 patients with CVD (CEAP C1- C6). Patients were assessed with a Visual Analogue Pain Scale (VAPS), the Venous Clinical Severity Score (VCSS) and the SF-36 quality-of-life questionnaire. Spearman correlation coefficients were calculated. RESULTS: There were positive correlations between the CEAP classification and scores for VAPS (0.815, p <0.000), VCSS (0.937, p <0.000), and SF-36 in the dimensions Physical Functioning: -0.791, p <0.000; Role Physical: -0.839; p <0.000; Bodily Pain: -0.684; General Health: -0.617, p <0.000; Role Emotional: -0.691, p <0.000). There was no correlation with Vitality: -0.003, p=0.979; Role Social: -0.188, p=0.740 or Mental Health: -0.085, p=0.421. CONCLUSIONS: There were positive correlations between CEAP and both VAPS and VCSS. Chronic Venous Insufficiency progressively affects quality of life (SF-36). Physical and emotional aspects are more severe at later stages of CVD. Vitality, Mental Health and Role Social can be negatively impacted from the early stages of the disease.

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The impact of obesity on venous insufficiency

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514551087 ◽

2014 ◽

Vol 30 (7) ◽

pp. 475-480 ◽

Cited By ~ 9

Author(s):

AC Seidel ◽

CEQ Belczak ◽

MB Campos ◽

RB Campos ◽

DS Harada

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Negative Impact ◽

Clinical Severity ◽

Chronic Venous Disease ◽

Venous Disease ◽

Chi Square ◽

Cross Sectional ◽

Ceap Classification ◽

The Impact

Association between chronic venous disease and obesity has recently been studied, with indications that it may worsen in obese patients. The aim of study was to correlate clinical classes of chronic venous disease according to Clinical Etiology Anatomy Pathophysiology (CEAP) classification and body mass index, as well as to compare the severity of chronic venous disease in obese and nonobese patients. This retrospective cross-sectional prevalence study was conducted at the Maringá State University and Belczak Vascular Center along a period of 2 years, consisting of a random sample of 482 patients with complaints compatible with chronic venous disease. Data obtained from patient’s files included gender, age, weight and height (for calculating body mass index), and clinical class (C) of chronic venous disease according to CEAP classification. Statistical analysis included Spearman’s correlation coefficient, Chi-square test (for comparing frequencies), and Student’s t-test (for comparing means). Significant positive correlation between body mass index and clinical classes was established for women (0.43), but not for men (0.07). Obesity (body mass index ≥ 30.0) was significantly more frequent in patients with chronic venous disease in clinical classes 3 (p < 0.001) and 4 (p = 0.002) and less frequent in patients with chronic venous disease in clinical class 1 (p < 0.001). This study evidenced significant correlation between body mass index and clinical classes of chronic venous disease in women, but not in men. It also corroborated the negative impact of obesity on the clinical severity of chronic venous disease.

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Diagnosis of Chronic Venous Disease of the Lower Extremities: The “CEAP” Classification

Mayo Clinic Proceedings ◽

10.4065/71.4.338 ◽

1996 ◽

Vol 71 (4) ◽

pp. 338-345 ◽

Cited By ~ 182

Author(s):

Robert L. Kistner ◽

Bo Eklof ◽

Elna M. Masuda

Keyword(s):

Lower Extremities ◽

Chronic Venous Disease ◽

Venous Disease ◽

Ceap Classification

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Association between lower extremity venous insufficiency and duration of atrial fibrillation

Phlebology The Journal of Venous Disease ◽

10.1177/0268355521994997 ◽

2021 ◽

pp. 026835552199499

Author(s):

Zeynep Yapan Emren ◽

Sadık Volkan Emren ◽

Fatih Ada ◽

Sefa Erdi Ömür ◽

Ferhat Dindaş

Keyword(s):

Lower Extremity ◽

Venous Blood ◽

Active Role ◽

Chronic Venous Disease ◽

Right Atrial ◽

Volume Index ◽

Venous Disease ◽

Atrial Volume ◽

Chronic Patients ◽

Ceap Classification

Objective Physiologic studies have shown that atrium has an active role in venous blood return from lower extremity. In this context we investigated the association between AF and chronic venous disease (CVD). Methods In this observational study we included 392 AF patients which were divided into two groups (chronic AF, 218 (56%)) and non-chronic. AF, 174 (44%)). These two groups were compared in terms of CVD after matching conventional risk factors for CVD. Results CEAP classification was different between chronic and non-chronic patients (C0–C2: 72% vs 47%; C3–C6: 28% vs 53% <0.001). Chronic AF patients had also higher rate of venous reflux on Doppler ultrasound (38% vs 16% P < 0.05). There was a correlation between AF duration, right atrial volume index and CEAP classification respectively (rho:0.314 p < 0.001), (rho:0.258, p < 0.001). Conclusion Prevalence of CVD is higher in patients with chronic AF. In addition, atrial volume is directly correlated with CVD.

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Duffy antigen / receptor for chemokines correlates with inflammatory reaction in rats with venous hypertension: implication for the pathogenesis of primary chronic venous disease

VASA ◽

10.1024/0301-1526/a000327 ◽

2014 ◽

Vol 43 (1) ◽

pp. 47-54 ◽

Cited By ~ 1

Author(s):

Weibin Huang ◽

Weiwei Qin ◽

Lei Lv ◽

Haoyv Deng ◽

Hao Zhang ◽

...

Keyword(s):

Mononuclear Cells ◽

Early Stage ◽

Antigen Receptor ◽

Venous Hypertension ◽

Skin Tissue ◽

Chronic Venous Disease ◽

Venous Disease ◽

Dependent Manner ◽

Time Points ◽

Duffy Antigen

Background: Duffy antigen / receptor for chemokines (DARC) possesses high affinity for several chemokine subgroups of CC and CXC. Although DARC has been shown to play a role in many inflammatory diseases, its effect on chronic venous disease (CVD) remains unidentified. We explored whether the expression of DARC in skin tissue was activated under venous hypertension as well as the relationships between DARC and inflammation. Materials and methods: The inflammation in a rat model of venous hypertension caused by a femoral arterial-venous fistula (AVF) was studied. At specified intervals the pressure in the femoral veins was recorded within 42 days. Hindlimb skin specimens were harvested at different time points. The expressions of DARC, interleukin-8 (IL-8), and monocyte chemotactic protein-1 (MCP-1) in skin tissue were examined. Mononuclear cells infiltrated in skin tissue were detected. Results: Femoral venous pressures in AVF groups increased significantly at different time points (P < 0.01). DARC was expressed in skin tissue and its expression level increased significantly in AVF groups from the 7nd day on and was enhanced in a time-dependent manner within 42 days (P < 0.05). Meanwhile, both MCP-1 and IL-8 had higher levels, accompanied by increased mononuclear cells infiltrating into skin tissue (P < 0.05). Conclusions: A rat AVF model which can maintain venous hypertension for at least 42 days is competent for researching the pathogenesis of CVD. DARC, which plays a role in the inflammation of skin tissue under venous hypertension, may become a new molecular target for diagnosis and treatment of CVD at a very early stage.

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