Terminology And New Definitions

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The CEAP classification deals with all forms of chronic venous disorders. The term chronic venous disorder (CVD) includes the full spectrum of morphological and functional abnormalities of the venous system from telangiectasias to venous ulcers. Some of these, like telangiectasias, are highly prevalent in the normal adult population, and in many cases the use of the term "disease" is not appropriate. The term chronic venous insufficiency (CVI) implies a functional abnormality of the venous system and usually is reserved for patients with more advanced disease including those with edema (C3), skin changes (C4), or venous ulcers (C5-6).

It was agreed to maintain the overall structure of the CEAP classification, but to add more precise definitions. The following recommended definitions apply to the clinical C classes in CEAP:

Telangiectasia: A confluence of dilated intradermal venules of less than 1 mm in caliber. Synonyms include spider veins, hyphen webs, and thread veins. Reticular veins: Dilated bluish subdermal veins usually from 1 mm in diameter to less than 3 mm in diameter. They usually are tortuous. This excludes normal visible veins in people with thin, transparent skin. Synonyms include blue veins, subdermal varices, and venulectasies. Varicose veins: Subcutaneous dilated veins equal to or more than 3 mm in diameter measured in the upright position. These may involve saphenous veins, saphenous tributaries, or nonsaphenous superficial leg veins. Varicose veins usually are tortuous, but tubular saphenous veins with demonstrated reflux may be classified as varicose veins. Synonyms include varix, varices, and varicosities. Corona phlebectatica: A fan-shaped pattern of numerous small intradermal veins on the medial or lateral aspects of the ankle and foot. This commonly is thought to be an early sign of advanced venous disease. Synonyms include malleolar flare and ankle flare. Edema: A perceptible increase in volume of fluid in the skin and subcutaneous tissue characteristically indenting with pressure. Venous edema usually occurs in the ankle region, but it may extend to the leg and foot. Pigmentation: A brownish darkening of the skin resulting from extravasated blood, which usually occurs in the ankle region but may extend to the leg and foot. Eczema: An erythematous dermatitis, which may progress to a blistering, weeping, or scaling eruption of the skin of the leg. It is most often located near varicose veins but

Bo Eklof, chair John Bergan Peter Gloviczki Robert Kistner Mark Meissner, secretary Gregory Moneta Frank Padberg Robert Rutherford Thomas Wakefield may be located anywhere in the leg. Eczema usually is seen in uncontrolled CVD but may reflect sensitization to local therapy.

Lipodermatosclerosis (LDS): Localized chronic inflammation and fibrosis of the skin and subcutaneous tissues of the lower leg, sometimes associated with scarring or contracture of the Achilles tendon. LDS is sometimes preceded by diffuse inflammatory edema of the skin, which may be painful and which is often referred to as hypo-dermitis. This condition must be distinguished from lymphangitis, erysipelas, or cellulitis by their characteristically different local signs and systemic features. LDS is a sign of severe chronic venous disease.

Atrophie blanche or white atrophy: Localized, often circular whitish and atrophic skin areas surrounded by dilated capillaries and sometimes hyperpigmentation. This finding is a sign of severe chronic venous disease and not to be confused with healed ulcer scars. Scars of healed ulceration also may have atrophic skin with pigmentary changes but are distinguishable by history of ulceration and appearance from atrophie blanche and are excluded from this definition.

Venous ulcer: Full thickness defect of the skin most frequently in the ankle region that fails to heal spontaneously and is sustained by CVD.

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