The care of patients with varicose veins and associated chronic ...

JOURNAL OF VASCULAR SURGERY
Volume 53, Number 16S Gloviczki et al 15S
Guideline 5. Laboratory evaluation
Guideline
No. 5. Laboratory evaluation
5.1 We recommend that in patients with chronic venous disease, evaluation
for thrombophilia is needed selectively for those with recurrent deep
vein thrombosis, thrombosis at a young age, or thrombosis in an
unusual site. Laboratory examination is needed in patients with longstanding
venous stasis ulcers (blood cell count and metabolic panel)
and in selected patients who undergo general anesthesia for the
treatment of chronic venous disease.
Guideline 6. Classification
Guideline
No. 6. Classification
6.1 We recommend that the CEAP classification be used for patients with varicose
veins. The basic CEAP classification is used for clinical practice, and the full
CEAP classification system is used for clinical research.
6.2 We recommend that primary venous disorders, including simple varicose
veins, be differentiated from secondary venous insufficiency and from
congenital venous disorders because the three conditions differ in
pathophysiology and management.
The basic CEAP classification is a simplified version,
suitable and easy for office use, and does not have the
details of the comprehensive CEAP classification, which
functions more as a research tool. As discussed in more
detail by Meissner et al, 13 for a patient with primary,
symptomatic varicose veins and full saphenous and perforator
incompetence (anatomic segments 2, 3, and 18
in Table III) with a small healed venous ulcer and skin
pigmentation, the comprehensive CEAP classification
would be C2,4a, 5,SEpAs,p,Pr2,3,18. Using the basic CEAP, the same patient would be
classified as C5,SEpAs,pPr. In the basic CEAP classification,
only the highest score is used to denote the clinical
class and only the main anatomic groups (s, p, and d) are
noted.
The revised format of the classification 77 includes two
elements in addition to the C-E-A-P findings: the date of
the examination and the level of the diagnostic evaluation:
Level 1: History, physical examination, Doppler examination
(handheld)
Level 2: Noninvasive—duplex scan, plethysmography
Level 3: Invasive or complex evaluation—contrast venography,
venous pressure measurements, IVUS, CT
venography, MR venography
GRADE of
recommendation
Level of
evidence
1. Strong A. High
quality
2. Weak B. Moderate
quality
C. Low or very
low quality
1 B
GRADE of
recommendation
Level of
evidence
1. Strong A. High
quality
2. Weak B. Moderate
quality
C. Low or very
low quality
1 A
1 B
The accuracy of the diagnosis increases with the addition
of imaging and invasive testing. Recording the date
and method used to confirm the clinical impression can be
added in parentheses after the CEAP recording as follows:
Full form: C 2,4a,5, S E p A s, p P r2,3,18 (Level 2, Feb 8, 2010)
Basic form: C 5, S E pA spP r (Level 2; Feb 8, 2010)
The main purpose of using the CEAP classification in
patients with CVD is to distinguish primary venous disease
from congenital varicosity and, most importantly, from
secondary, post-thrombotic venous insufficiency. 53 Evaluation
and treatment of the three conditions are distinctly
different.
OUTCOME ASSESSMENT
Outcome assessment of therapy of varicose veins and
more advanced CVD includes standardized objective criteria
that reflect patient symptoms, characteristic signs, and
objective measures of functional and disease-specific
QOL. 104
Generic QOL instruments
Generic QOL measures allow comparison with population
norms and other disease states and provide a measure