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CEAP, CEAP Little Birdie

Recently, I saw an excellent presentation by Jodi Schoenhaus, DPM about chronic venous insufficiency1. During this lecture, Dr Schoenhaus related that for those of us treating these conditions, it is a requirement to document the classification of disease. This was news to me! Like many podiatrists, I treat manifestations of chronic venous disease, especially venous ulcers, so this is an important topic. In an ironic confluence of events, just yesterday I ran a journal club with some students discussing this very topic.

Venous disease is classified by the CEAP classification, and it is this system to which Dr Schoenhaus referred. Let's take a look at the CEAP classification, so we can all be better informed.

"CEAP" is a mnemonic-named descriptive classification covering the important aspects of venous disease. Remember, this classification does not measure disease severity or treatment outcomes. A recent update to the classification was published in 20202, so today's discussion will use the data from the update.

C = Clinical appearance
E = Etiology
A = Anatomy
P = Pathophysiology

Class Description
C - Clinical Appearance*
C0 No visible signs of venous disease
C1 Telangiectasias or reticular veins
C2 Varicose veins
C3 Edema
C4
C4a
C4b
C4c

Pigmentation or eczema
Lipodermatosclerosis or atrophie blanche
Corona phlebectatica
C5 Healed venous ulcer
C6 Active venous ulcer
*r subscript added if recurrent
E - Etiology
Ep Primary - degeneration of the valves +/- wall leading to reflux
Esi Secondary - intravenous
  • Venous congestion leading to wall or valve damage.
  • Ex. DVT, traumatic AV fistulas
Ese Secondary - extraveonous
  • No wall or valve damage
  • Due to hemodynamic changes such as CHF, renal disease, obesity, congestion from masses.
Ec Congenital
En No cause
A - Anatomy - which veins are involved
As Superficial
Ad Deep
Ap Perforator
An No location identified
P - Pathophysiology
Pr Reflux
Po Obstruction
Pro Reflux + Obstruction
Pn No pathology

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In order to fully complete a CEAP classification on a patient, it is required to obtain a venous ultrasound that examines the superficial and deep veins as well as the perforators. According to Dr Schoenhaus, an important tip is to order standing venous ultrasounds to examine the superficial system and supine ultrasound for the deep system1. One can then properly characterize the important aspects of the patient's venous disease to guide further successful treatment.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
jarrod@podiatry.com

References
  1. Schoenhaus, J. Lecture: Skin Manifestations of Venous Disease. Updates in Dermatology: Practical Pearls Conference. American College of Podiatric Medicine. July 23, 2022.
  2. Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H, Bush RL, Blebea J, Carpentier PH, De Maeseneer M, Gasparis A. The 2020 update of the CEAP classification system and reporting standards.J Vascu Surg Venous Lymphat Disord. 2020 May;8(3):342-352.
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