chronic venous disorders, varicose vein, CEAP classification, lipodermatosclerosis, Klippel- Trenaunay syndrome DVT CVD
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1 Online publication August 27, 2009 chronic venous disorders: CVD CEAP 4 CEAP CVD J Jpn Coll Angiol, 2009, 49: chronic venous disorders, varicose vein, CEAP classification, lipodermatosclerosis, Klippel- Trenaunay syndrome chronic venous disorders: CVD 1 deep vein thrombosis: DVT CVD CVD CVD CVD DVT DVT CVD BMI body mass index DVT CVD THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 49,
2 Table 1 CEAP classification of lower extremity chronic venous disease Clinical sign C0: no visible or palpable signs of venous disease C1: Telangiectases or reticular veins C2: Varicose veins C3: Edema without skin changes C4: Skin changes except ulceration (e.g., pigmentation, venous eczema, lipodermatosclerosis) C5: Healed ulceration C6: Active ulceration Etiological classification Ec: Congenital Ep: Primary Es: Secondary Anatomical distribution A S: Superficial veins 1: Telangiectases or reticular veins, 2: Greater saphenous vein (above knee), 3: Greater saphenous vein (below knee), 4: Lesser saphenous vein, 5: Nonsaphenous A D: Deep veins 6: Inferior vena cava, 7: Common iliac, 8: Internal iliac, 9: External iliac, 10: Pelvic (gonadal, broad ligament), 11: Common femoral, 12: Deep femoral, 13: Superficial femoral, 14: Popliteral, 15: Tibial (anterior, posterior, or peroneal), 16: Muscular (gastrocnemius, soleal, other) A P: Perforating veins 17: Thigh, 18: Calf Pathophysiologic dysfunction P R: Reflux P O: Obstruction P R, O: Reflux and obstruction CVD CVD Clinical sign Etiologic classification Anatomical distribution Pathophysiologic dysfunction 4 CEAP 1994American Venous Forum 2, Table 3) 1 CEAP 1 7 C0 CVD CVD C1telangiectasis reticular vein 1 mm 3 mm 3 mm (varicose vein) C2 4) C3 DVT postthrombotic syndrome 202 Vol. 49, 2009
3 pitting edema CVD non-pitting edema 10cm 10cm C4 C4 1/3 1/3 lipodermatosclerosis 1/3 hypodermatitis atrophie blanche C6 C ) C6 6) 7) 20 30mmHg CVD 90mmHg 100 8) , 5, 9, Ep Es DVT Vol. 49,
4 varicography CT MR Ec Klippel-Trenaunay Brodie- Trendelenburg ) Perthes DVT 20 4 P R P OP R,O Brodie- Trendelenburg Vol. 49, 2009
5 0.5 11) DVT CEAP CVD 1 Padberg FT Jr: Classification and clinical and diagnostic evaluation of patients with chronic venous disorders. In: Vascular Surgery 6th edition. Rutherford RB ed, Elsevier Saunders, Philadelphia, 2005, Beebe HG, Bergan JJ, Bergqvist D et al: Classification and grading of chronic venous disease in the lower limbs. A consensus statement. Eur J Vasc Endovasc Surg, 1996, 12: Eklöf B, Rutherford RB, Bergan JJ et al: Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg, 2004, 40: Allegra C, Antignani PL, Bergan JJ et al: The C of CEAP suggested definitions and refinements An International Union of Phlebology conference of experts. J Vasc Surg, 2003, 37: Mayberry JC, Moneta GL, Taylor LM Jr et al: Fifteen-year results of ambulatory compression therapy for chronic venous ulcers. Surgery, 1991, 109: Browse NL, Burnand KG: The cause of venous ulceration. Lancet, 1982, 2: Thomas PR, Nash GB, Dormandy JA: White cell accumulation in dependent legs of patients with venous hypertension: a possible mechanism for trophic changes in the skin. Br Med J (Clin Res Ed), 1988, 296: Nicolaides AN, Hussein MK, Szendro G et al: The relation of venous ulceration with ambulatory venous pressure measurements. J Vasc Surg, 1993, 17: Padberg F Jr, Cerveira JJ, Lal BK et al: Does severe venous insufficiency have a different etiology in the morbidly obese? Is it venous? J Vasc Surg, 2003, 37: Mekkes JR, Loots MA, Van Der Wal AC et al: Causes, investigation and treatment of leg ulceration. Br J Dermatol, 2003, 148: Medical Examination of Venous Diseases Hiroyuki Ishibashi Department of Vascular Surgery, Aichi Medical University, Aichi, Japan chronic venous disorders, varicose vein, CEAP classification, lipodermatosclerosis, Klippel-Trenaunay syndrome Chronic venous disorders (CVD) are pathophysiological states produced by various venous problems of the lower legs due to valve dysfunction or blood return disturbance. The most representative disorder is varicose veins of the leg. The CEAP classification is an international clinical classification that consists of four categories: clinical signs, etiologic classification, anatomic distribution, and pathophysiological dysfunction. Although the CEAP classification is somewhat complicated, it is possible to make an accurate diagnosis in most CVDs with the assistance of Doppler or duplex ultrasonography. (J Jpn Coll Angiol, 2009, 49: ) Vol. 49, 2009 Online publication August 27,
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