Invited commentary

Abstract

The advantages of a uniform nomenclature are so obvious that it is surprising no attempts to develop one for chronic venous diseases (CVD) were made until the 1990s. Development of the CEAP by the American Venous Forum (AVF) in 1993 to 1994, followed by a rapid international acceptance of this classification, introduced a uniformity of reporting, and the systematic investigation of CVD commenced. It soon became clear that what seems to be a simple and precise description of the signs of venous disorders is a matter of disagreement and controversy. The original CEAP classification specified four signs: venous dilation (including telangiectases, and reticular and varicose veins), edema, skin pigmentation, and ulcer. Malleolar flare was included in the C1 clinical class. Despite the perceived clarity of CEAP, analysis of the European Venous Registry demonstrated significant variability in assigning patients to the clinical classes. This prompted the international consensus meeting in Rome in 2001, and refinements of the clinical classification, the C in CEAP.1Eklöf B. Rutherford R.B. Bergan J.J. Carpentier P.H. Gloviczki P. Kistner R.L. et al.Revision of the CEAP classification for chronic venous disorders: consensus statement.J Vasc Surg. 2004; 40: 1248-1252Abstract Full Text Full Text PDF PubMed Scopus (1395) Google Scholar Additional signs, such as atrophie blanche, eczema, and lipodermatosclerosis were described and included in definition of clinical classes. The term “malleolar flair” was replaced by a synonym “corona phlebectatica.” Although this sign was not identified as a criterion for any of the C0-C6 clinical classes, it was stated that corona phlebectatica is “commonly thought to be an early sign of advanced venous disease.” The article by Uhl et al is a further attempt to improve the precision of descriptions and the reliability of the classification. It demonstrated that only two of the four elements of the current definition (blue telangiectases and stasis spots) can potentially serve as markers of the CVD severity. These data support the authors' continuous effort to modify the CEAP classification to include corona phlebectatica in the C4 clinical class. Knowing that CEAP, however imperfect, already serves its purpose, one may wonder how much improvement it needs and how much of the change is reasonable. After all, CEAP is an empiric descriptive classification and, as such, may be replaced in the future by a more accurate system reflecting specific underlying pathologic processes and mechanisms. Acquiring this knowledge, however, requires consistency, and changes in classification may jeopardize the results of the 15-year progress resulted from creation and adaption of CEAP. A remarkable aspect of this publication is that at the time when in-depth investigation of disease processes at all levels of biologic organization—from system to submolecular—became scientific routine, venous diseases are still at a stage when so much energy is devoted to issues of descriptive classification. This underlines a greater problem of lack in knowledge of basic physiological and pathologic mechanisms involved. Clinical analysis of the corona phlebectaticaJournal of Vascular SurgeryVol. 55Issue 1PreviewThe corona phlebectatica (CP) is classically described as the presence of abnormally visible cutaneous blood vessels at the ankle with four components: “venous cups,” blue and red telangiectases, and capillary “stasis spots.” Previous studies showed that the presence of CP is strongly related to the clinical severity of chronic venous disorders (CVD) and the presence of incompetent leg perforators. The aim of this study was to select the most informative components of the CP in the assessment of the clinical severity of CVD patients. Full-Text PDF Open Archive