Previous Classifications Of

The most commonly used classification, particularly in Europe, was Widmer's classification from 19781 of chronic venous insufficiency:

Stage I: Edema and dilated subcutaneous veins with corona phlebectatica

Stage II: Trophic lesions of the skin with hyper- or depig-

mented areas Stage III: Healed or active ulcer

The criticism against this clinical classification was the non-specificity of Stage I, and the absence of differentiation between trophic changes in Stage II.

In 19792 Hach suggested a grading of great saphenous vein (GSV) incompetence:

Grade I: Reflux in the groin Grade II: Reflux to above the knee Grade III: Reflux to just below the knee Grade IV: Total reflux to the ankle

Hach's thesis was that in severe reflux of the GSV, a viscious internal circle developed because of the large venous blood volume with dilatation of the popliteal and femoral veins leading to deep venous incompetence if the GSV incompetence was not treated.

In 1980,3 Partsch asked whether in patients with CVD, you could achieve further improvement from other means after compression therapy. Could surgery or sclerotherapy be helpful? He recommended a classification based on involvement of superficial, perforator, and deep veins using objective measures such as foot volumetry and ambulatory venous pressure to discriminate between "betterable" (besserbare) and "not betterable" (nicht besserbare) patients.

In 1985,4 Sytchev published a classification very similar to the present CEAP classification, as follows.

Clinical classes

Stages of regional circulatory-trophic disorders:

• Compensation

• Decompensation (cyanosis, edema, cruralgia, or leg pain)

Degrees:

• At the beginning of the day

Phases:

• Functional trophic disorders (hyper-, hypo-, and anhidrosis of the skin)

• Preulcer condition of tissues

• Trophic ulcers

Etiology

• Primary venous dilatation

• Secondary (postthrombotic) occlusion and recanalization

• Congenital dysplasias

Central hemodynamics

• Compensation

• Decompensation

— Underloaded

— Overloaded

The same year,5 Pierchalla and Tronnier suggested differentiation between primary and secondary (postthrombotic) disease, and between superficial, perforator, and deep venous disease using objective measures.

In 1988,6 Porter et al. published reporting standards for venous disease developed by an ad hoc committee for the Society for Vascular Surgery (SVS) and the North American chapter of the International Society for Cardiovascular Surgery (ISCVS). This was similar to and based on the Widmer classification with the addition of etiology and anatomic distribution. This was the stimulus for the CEAP classification that followed later.

In 1991,7 Cornu-Thenard et al. published a clinical classification of the severity of varicose veins by inspection and palpation and calculated the sum of maximum diameter at 7 sites of the leg.

In 1992,8 Enrici and Caldevilla published a clinical classification on the evolution of the postthrombotic syndrome:

Stage 1: Early postthrombotic syndrome with painful swelling of the leg with distal venous hypertension and veno-graphically demonstrating residual obstruction of the deep veins with competent perforators Stage 2: Compensatory hypertrophy of the musculo-venous calf muscle pump Stage 3: Stage 2 plus appearance of secondary varicose veins

Venography shows recanalization with varying reflux with incompetent perforators;

Stage 4: Advanced chronic venous insufficiency with development of a vicious venous recirculation with lipodermatosclerosis and ulceration due to venous hypertension

Stage 5: Phlebo-arthrotic syndrome with immobilization of the ankle

Leads to atrophy of the calf muscle with large circumferential ulcers

Stage 6: Secondary, postthrombotic lymphedema

In 1993,9 Miranda et al. published a clinical classification:

Stage I: Dilatation of GSV 7 mm by duplex scanning Stage II: Dilatation of GSV>7 mm without skin changes Stage III: Stage II plus skin changes Stage IV: Stage III plus active or healed ulcer

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