How is vein disease of the legs classified?
Almost all venous disease is caused by faulty valves located in the larger veins of the legs. By design, these valves ensure that blood flows in the correct direction, e.g. up the legs and towards the heart. For a multitude of reasons, these valves can become stretched out or otherwise damaged. As this occurs blood begins to trickle back down the leg and begins to pool. This is known as venous reflux. It’s an ongoing process, and without treatment a patient’s symptoms almost always become worse over time.
As with many medical conditions, venous disease presents in a variety of ways. Those affected may display different symptoms, and cases range in severity from minor cosmetic defects to painful, non-healing ulcers.
Vein disease is classified using the CEAP system
Vein disease is presently classified using a six-point scale known as the CEAP system. Prior to CEAP, there was no single method healthcare professionals could use to classify vein disease. Instead, they would simply describe individual symptoms and rate them as mild, moderate, or severe. This approach was inefficient, lacked specificity, and could hamper communication between providers.
Today, CEAP is the accepted standard used by all healthcare professionals when describing lower extremity vein disease. It’s designed to be very specific and facilitate good communication. In short, it offers everything that the previous system, or lack thereof, failed to provide.
The 7 stages of the CEAP classification system
C0: This describes a fully functioning, healthy venous system. The C0 patient’s leg veins conduct blood back towards the heart exactly as they’re supposed to.
C1: The presence of spider veins can be noted. These web-like clusters of tiny veins are also known as reticular veins. As a condition, the presence of spider veins is known as telangiectasia.
By themselves, spider veins are nothing more than a cosmetic nuisance. They do, however, indicate some level of reflux in the underlying larger veins of the legs. As such, they’re a direct precursor to varicose veins.
C2: The formation of varicose veins. Patients begin to experience more venous reflux as the disease process continues which causes more blood to pool in the legs. This leads to increased pressure, which in turn causes previously invisible surface veins to swell. Over time they become stretched out and can eventually become thick, winding varicose veins.
The C2 stage indicates moderately severe leg vein disease. Many patients begin to experience physical symptoms such as achiness in the legs, swelling, cramping, and a sense of heaviness. Without the proper treatment it’s highly likely that the condition will progress to the following stages.
C3: The presence of edema. This is the medical term for moderate to severe fluid retention and swelling. Conservative methods such as compression stockings and edema pumps can manage symptoms but won’t help the underlying condition. As with C2 and subsequent categories, a patient’s vein disease will almost certainly worsen if not properly treated.
C4: Visible skin changes. Chronic fluid retention often leads to changes in the color, texture, and general appearance of the skin. The presence of eczema and brownish, purplish, or reddish blotches is common in C4 patients.
C5: A history of healed ankle ulcers. Left unchecked, chronic fluid retention causes a dramatic increase in pressure within a patient’s leg veins. This in turn can lead to impaired circulation which can cause a breakdown of the overlying skin. C5 patients begin to experience painful ulcers, especially around the ankles, which heal on their own without intervention.
C6: Active lower extremity ulcers. Fortunately, only about 1% of all patients with vein disease will progress to CEAP stage 6. As their condition worsens with time, C6 patients begin to form ulcers which won’t heal without specialty wound care. At this point treatment is highly recommended and may indeed be medically necessary.