THE CEAP SURVEY

RATIONALE AND PRELIMINARY RESULTS

Fausto Passariello1, Malay Patel2, Pier Luigi Antignani3

1Vascular Surgeon, Centro Diagnostico Aquarius, Napoli, Italy

2Vascular Surgeon & Endovascular Specialist, Ahmedabad, India

3Angiologist. Director Vascular Center, Nuova Villa Claudia, Rome, Italy

Hemodyn 2015

DISCLOSURE I HAVE NO CONFLICT OF

INTEREST

The VASCULAB Foundation

Napoli, Italia November 3rd-5th

2015

An Online Vasculab Survey

JOURNAL OF VASCULAR SURGERY - Volume 40, Number 6, December 2004

(C)EAP Clinical classification

C0: no visible or palpable signs of venous disease

C1: telangiectasies or reticular veins

C2: varicose veins

C3: edema

C4a: pigmentation or eczema

C4b: lipodermatosclerosis or atrophie blanche

C5: healed venous ulcer

C6: active venous ulcer

S: symptomatic, including ache, pain, tightness,

skin irritation, heaviness, and muscle cramps, and

other complaints attributable to venous dysfunction

A: asymptomatic

Ethiologic classification

Ec: congenital

Ep: primary

Es: secondary (postthrombotic)

En: no venous cause identified

Anatomic classification

As: superficial veins

Ap: perforator veins

Ad: deep veins

An: no venous location identified

Pathophysiologic classification

Basic CEAP

Pr: reflux

Po: obstruction

Pr,o: reflux and obstruction

Pn: no venous pathophysiology identifiable

Superficial veins (s): 1 Telangiectases / reticular veins

Greater (long) saphenous (GSV)

2 Above-knee

3 Below-knee

4 Lesser (short) saphenous (LSV)

5 Non-saphenous

Deep veins (d): 6 Inferior vena cava

Iliac

7 Common

8 Internal

9 External

10 Pelvic - Gonadal, broad ligament, other

Femoral

11 Common

12 Deep

13 Superficial

14 Popliteal

15 Crural - anterior tibial, posterior tibial, peroneal (all paired)

16 Muscular - Gastrocnemial, soleal, other

Perforating veins (p): 17 Thigh

18 Calf

The advanced terms

Original and Revised CEAP

A & P mismatch

In the 2004 revision

• the (A)natomical details are shifted into

• the (P)athological description

However, subsequent papers

(Padberg, 2005)

DO NOT REPORT

the variation, as it were only a mistake

Dis Mon 2005;51:176-182 DM, February/March 2005

The original classifies the anatomical

segment designations into the anatomical

(A) category, while the revision includes it

into the pathological (P) category. More

exactly into the reflux (R) or obstruction

(O) subgroups.

preliminary

results

N. 34 - L o w n u m b e r o r p a r t i c i p a n t s

An Online Vasculab Survey

The CEAP Survey preliminary results

Survey statistics

Q2) Phlebolymphedema should be

considered together with venous edema in

the C3 class or separated instead and

identified with a L subscript (C3L) ?

Otherwise could it be excluded completely

from CEAP ?

Q1) C0 is not typical of a healthy person,

but of a phlebological patient who is

clinically negative. In other words, C0 En

An Pn is not considered in CEAP, because

some items must be positive in the letters

E,A,P.

Do you think that these features should be

more clearly stated in the CEAP text ?

Q3) In the ethiological class E, the C, P

and S items can be sometimes

simultaneously present.

Should a multiple selection be allowed?

q1

Yes

No

I don't know

q2

C3

C3L

excluded

I don't know

q3

Yes

No

I don't know

Superficial veins (s): 1 Telangiectases / reticular veins

Greater (long) saphenous (GSV)

2 Above-knee

3 Below-knee

4 Lesser (short) saphenous (LSV)

5 Non-saphenous

Deep veins (d): 6 Inferior vena cava

Iliac

7 Common

8 Internal

9 External

10 Pelvic - Gonadal, broad ligament, other

Femoral

11 Common

12 Deep

13 Superficial

14 Popliteal

15 Crural - anterior tibial, posterior tibial, peroneal (all paired)

16 Muscular - Gastrocnemial, soleal, other

Perforating veins (p): 17 Thigh

18 Calf

The advanced terms

The A – P

CEAP inconsistency

The A - P CEAP inconsistency

q4 - Case A: Original CEAP: As2,3,5 Pr,o. 2004 CEAP Revision: As Prs2,5,os3. Where will you place

the advanced items ?

the A letter

the P letter

both

I don't know

q5 - Case B: Original CEAP: As2,3,5 Pr,o. 2004 CEAP Revision: As Prs2,3,5,os3. Where will you place

the advanced items ?

the A letter

the P letter

both

I don't know

q6 - Should in general the advanced terms be included into the A or the P letter or both ?

the A letter

the P letter

both

I don't know

Reflux and thrombosis: chronic SVT and DVT sequelae

q7 - In the P class, should the (R, O) items allow multiple choices, thus eliminating the need of the RO item ?

Yes

No

I don't know

q8 - Should CEAP differentiate between chronic SVT and DVT sequelae ?

Yes

No

I don't know

q9 - Should CEAP differentiate between complete and partial thrombosis ?

Yes

No

I don't know

q10 - should CEAP differentiate between partial thrombosis which does not progress to occlusion and partial recanalization ?

Yes

No

I don't know

q11 - Which relationship between CEAP and shunt classification

Clearly inconflict

No conflict, onlycomplementaryviews

I don't know

q12 - Should CEAP include information from the shunt classification ?

Yes

No

I don't know

q13 - Regarding the extension of CEAP, attaching a detailed hemodynamic information (ChEAP), which could be its practical use ? useful

interesting but itmust be changed

completelyuseless

I don't know

CEAP and

shunt

classification

1

Global view

about CEAP

q14 - Do you use the CEAP classification routinely ?

Yes

No

q15 - Do you find the CEAP classification useful in your clinical practice ?

Yes

No

I don't know

q16 - In your opinion which part of the CEAP is the most common and appropriate to use? Clinical

Ethiological

Anatomical

Pathophysiological

No part

q17 - Do you find CEAP in its complete form easy to use?

Yes

No

I don't know

q20 - Do you feel that a CEAP revision is necessary ?

Yes

No

I don't know

q19 - Would you recommend a simplified version of CEAP using only C and P ?

Yes

No

I don't know

2

Global view

about CEAP

q18 - In several countries the C class is a criterion to select the reimbursement. Is this acceptable ?

Yes

No

I don't know

The CEAP Survey preliminary results

Survey appreciation

CEAP Remarks (1)

CEAP

does not allow backward changes

from C5 to C4 (a or b)

from C4b to C2

does not differentiate between

complete obstruction

partial (recanalized) obstruction

does not Interfere with Chiva Classification

N1 – N4

shunts classification