Summary of diagnostic and characteristic parameters of C0 to C2 patients based on the CEAP2020 classification

Abstract

Objectives: Hemodynamic changes in C₀ to C₂ according to the clinical/etiological/anatomical/pathophysiological classification have not been analyzed extensively. We intend to investigate the characteristics of early stage venous disease using venous clinical severity score (VCSS), heaviness/ache/swelling/throbbing/itching (HASTI) score and duplex ultrasound (DUS) derived parameters.

Methods: From Aug. 2020 to Jul. 2021, consecutive patients were categorized according to the clinical/etiological/anatomical/pathophysiological 2020 classification. The vein diameter (mm), reflux time (s), cross-sectional area (cm²), peak and mean reflux velocity (cm/s), and total reflux volume (mL) were documented in the superficial system and deep system. VCSS and HASTI scores were assessed and DUS parameters were analyzed. A P value of less than .05 was considered statistically significant.

Results: We studied 257 consecutive patients (142 female) with 371 limbs. The mean age was 50.96 ± 13.27 years (range, 20-81 years; median, 53 years) with an average body mass index of 24.03 ± 2.96 kg/m² (range, 17.00-33.06 kg/m²; median, 23.67 kg/m²). The proportion of clinical (C) category was as followed: 47 C_0S (12.67%), 45 C₁ (12.13%), and 279 C₂ (75.20%). There were 42.6% of C₀ and 62.2% of C₁ associated with some form of venous reflux, Pr (pathology [P]-reflux). Reflux of the great saphenous vein above the knee (GSVa) was the most commonly affected vein segment from C_0-2. C₁ differed from C₀ only by age and severity scores with a cut-off value of 1 for both VCSS and HASTI. Larger saphenous veins diameter (GSV and small saphenous vein) were seen in Pr (P-reflux) than Pn (P-none) of C₀ cases. Larger deep vein diameters (common femoral vein, femoral vein, and popliteal vein) were evident in Pr versus Pn of C₁ cases. In C₂, the popliteal vein, saphenofemoral junction, and GSVa were dilated in Pr cases.

Conclusions: Both HASTI and VCSS were discriminative from C₀ to C₂. C₀ differed from C₁ by age and severity scores as DUS characteristics were not significantly different between the two groups. Vessel diameter played a discriminative role in distinguishing Pn versus Pr cases in each C_0-2 category. GSVa was the most frequent reflux segment irrespective of reflux types.

Keywords: Clinical/etiological/anatomical/pathophysiological classification (CEAP); Duplex ultrasound (DUS); Early stage chronic venous disease; Heaviness/ache/swelling/throbbing/itching (HASTI); Venous clinical severity score (VCSS).