Page 283 - Libro 2

17 — Venous Valvular Insufficiency Testing
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Clinical Classification
The clinical classification has seven classes from C 0
to C6, pending extremity conditions:
• C0: no venous insufficiency signs or symptoms
• C1: telangiectasias (spider veins) and/or reticu-
lar veins (􏰀3 mm in diameter)
• C2: varicose veins ( 􏰁3 mm in diameter)
• C3: edema
• C4: skin changes, presently subdivided into:
• C4A: minor skin changes
• C4B: major skin changes such as lipodermato-
sclerosis
• C5: healed skin ulcers
• C6: open skin ulcers
The authors recommend a subdivision of C3 into: • C3A: intermittent, functional swelling
• C3B: classical, constant edema
Etiologic Classification
The etiologic classification has four classes:
• Ep: CVVI is the major cause of clinical
manifestations
• Es: CVI or CVVI is secondary to deep venous
thrombosis or other pathology
• Ec: CVI or CVVI has a congenital origin; for
example, venous malformations or lack of valves
• En: unknown etiology, no venous etiology
identified
Anatomical Classification
The anatomical classification has three abnormal classes or a combination of such classes, and the class describing no findings:
• Ad: CVI or CVVI affects the deep veins
• As: CVI or CVVI affects the superficial veins
• Ap: CVI or CVVI affects the perforating veins
• Ads, Adp, Asp, and Adsp are multiple combi-
nations
• An: no venous anatomy identified
Pathophysiologic Classification
The pathophysiologic classification describes two primary abnormalities, combined or not, and a class without apparent findings:
• Pr: reflux or reverse venous flow
• Po: chronic venous obstruction
• Pro: a pathological combination
• Pn: no venous pathophysiology identified
One of the changes in the revised classification
was to consider varicose veins as 􏰁3 mm rather than 􏰁4 mm in diameter. Most clinical articles use at least the clinical CEAP classification to describe the pa- tients studied; the authors recommend that statistics
be conducted for each class without bundling patients with different conditions in the same group. Another recommendation is a venous segmental disease score based on the veins involved.20
CLINICAL SEVERITY SCORE21
The CEAP classification is descriptive. The clinical severity score attempts to determine a numerical, quantifiable index, mostly for longitudinal research comparisons. A summary of the guidelines for venous clinical severity score lists 10 attributes:
• 1: pain
• 2: varicose veins
• 3: edema
• 4: skin pigmentation
• 5: inflammation
• 6: induration
• 7: number of active ulcers
• 8: duration of active ulcers
• 9: size of active ulcers
• 10: compressive therapy
Each attribute is then scored from 0 to 3 for a
maximum of 30 points: • 0: Absent
• 1: Mild
• 2: Moderate
• 3: Severe
Note: The clinical severity score has yet to have the acceptability and common practice of the clinical CEAP classification.
DISABILITY SCORE21
A summary of the guidelines for the venous disabil- ity score lists the conditions of the patient as:
• 0: asymptomatic
• 1, 2, 3: symptomatic
• 1: able to carry out usual activities without
compressive therapy
• 2: able to carry out usual activities only with
compressive therapy and/or leg elevation
• 3: unable to carry out usual activities even with
compressive therapy and/or leg elevation Usual activities are the activities before the onset
of disability due to venous disease.
QUALITY OF LIFE QUESTIONNAIRES22–25
Awareness of a dual role is growing in medicine. Clinicians are concerned not only with the provi- sion of successful physiopathological treatment, but also with improving the quality of life for pa- tients. Patients’ perceptions of successful treatment is being analyzed with quality of life questionnaires. Such questionnaires are divided according to the