JOURNAL OF VASCULAR SURGERY
Volume 53, Number 16S
Gloviczki et al 15S
Guideline 5. Laboratory evaluation
Guideline |
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GRADE of |
Level of |
No. |
5. Laboratory evaluation |
recommendation |
evidence |
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1. Strong |
A. High |
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quality |
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2. Weak |
B. Moderate |
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quality |
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C. Low or very |
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low quality |
5.1 |
We recommend that in patients with chronic venous disease, evaluation |
1 |
B |
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for thrombophilia is needed selectively for those with recurrent deep |
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vein thrombosis, thrombosis at a young age, or thrombosis in an |
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unusual site. Laboratory examination is needed in patients with long- |
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standing venous stasis ulcers (blood cell count and metabolic panel) |
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and in selected patients who undergo general anesthesia for the |
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treatment of chronic venous disease. |
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Guideline 6. Classification
Guideline |
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GRADE of |
Level of |
No. |
6. Classification |
recommendation |
evidence |
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1. Strong |
A. High |
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quality |
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2. Weak |
B. Moderate |
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quality |
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C. Low or very |
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low quality |
6.1 |
We recommend that the CEAP classification be used for patients with varicose |
1 |
A |
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veins. The basic CEAP classification is used for clinical practice, and the full |
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CEAP classification system is used for clinical research. |
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6.2 |
We recommend that primary venous disorders, including simple varicose |
1 |
B |
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veins, be differentiated from secondary venous insufficiency and from |
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congenital venous disorders because the three conditions differ in |
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pathophysiology and management. |
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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 classification77 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 venog-
raphy, venous pressure measurements, IVUS, CT venography, MR venography
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: C2,4a,5, S Ep As, p Pr2,3,18 (Level 2, Feb 8, 2010) Basic form: C5, S EpAs pPr (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