Chronic venous insufficiency and leg ulceration: Principles and vascular biology

DEFINITIONS Chronic Venous Insufficiency Chronic venous insufficiency (CVI) is a term that is used to describe changes in the leg that include a variety of different clinical problems, which are caused by several types of abnormalities in the veins, and which may occur at a number of different locations in the leg. For these reasons it has been difficult to make accurate comparisons of reports of chronic venous insufficiency from different institutions. As a result attempts have been made to formulate systems of classification that enable accurate comparisons to be made. The most recent classification, referred to as the CEAP classification, was devised by an international panel and encompasses features of some of the earlier classifications. This classification has four categories which include – Clinical (C), Etiology (E), Anatomy (A) and Pathophysiology (P). Within each category the different levels are each given a number or a letter or both. The clinical classification has seven levels from no visible or palpable signs of venous disease through to skin changes with active ulceration (table 25.1). In addition the Clinical categories are further characterized according to the presence or absence of symptoms. The Etiological classification recognizes the roles of congenital (Ec), primary (Ep) and secondary (Es) causes in venous dysfunction. The Anatomical classification can be represented as a simple or more detailed form. The simple form refers to the site at which the veins are involved as superficial (As), deep (Ad) or perforating (Ap).