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Rosen Vein Lectures Diagnosis, Part 3: Classification

Pop Quiz:

What do Chicago (and the Northern Suburbs) have in common with Antarctica? If you can’t answer the question then you are likely reading this on the veranda of your winter refuge someplace far away and warm. Yes, I still have sympathy for you and your vein issues…but perhaps just a bit less than those who are slugging it out here with me in that frozen wasteland we call Chicagoland.

When last we left off, I was describing how vein disease gets diagnosed. Once the history, physical exam and ultrasound are performed, enough pieces of the puzzle exist to put together a coherent picture. The way Phlebologists (doctors like me who specialize in vein disease) describe such a picture is by using the “C.E.A.P” system. This allows doctors to get a global view of a particular patient’s disease as well as having a way of consistently communicating patient data with other physicians and allied health professionals. In addition, knowing which particular patients benefited from particular treatment regimens allows researchers to develop evidenced-based recommendations that are clinically relevant.
The C.E.A.P system takes into account:
Clinical Signs
Etiology of the problem
Anatomic location of a patient’s disease
Let’s take them one at a time…

1. Clinical Calssification:

C0: No visible signs of venous disease
C1: Telangiectasias (<1mm) or Reticular veins (1-3mm)
C2: Varicose veins (>3mm)
C3: Edema (swelling)
C4: Skin Changes


b)Atrophy blanche

C5: Healed ulcer
C6: Active ulcer

Beyond C0-6 there is a subclassification regarding Symptoms(ache,pain,heaviness,tightness,cramping,itching).
S: symptomatic
A: Asymptomatic

2. Etiologic Classification:

Ec (congenital)
Ep (primary)
Es (secondary)
En (no venous etiology identified)

3. Anatomic Classification
As (superficial veins)
Ap (perforator)
Ad (deep)
An (no venous location identified)

4. Pathophysiologic Classification
Pr (reflux)
Po (obstruction)
Pr,o (both reflux & obstruction identified)
Pn (no venous pathophysiology identified)

There’s an advanced CEAP that takes into account EXACTLY which veins you found the problem in…but we’ll leave that to the researchers.

Finally, the C.E.A.P. classification of a patient must take into account the date and the setting where the exam was performed, or the Level of Examination:
Level I: Office visit with an History & Physical Exam and Doppler examination only (no full ultrasound)
Level II: Non-invasive vascular lab or office where a full ultrasound study is performed
Level III: Invasive studies or complex imaging such as a venogram or MRI/MRV study.

At Rosen Vein Care, your initial consultation may include a diagnostic ultrasound detailing the condition of the relevant parts of your venous system. Immediately after your history, physical exam and ultrasound study is performed, I will share my findings with you. For those who like learning about their bodies, I LOVE teaching during ultrasound exams and am happy to give you a “tour” of your legs! Once the ultrasound is completed, we will discuss the benefits and risks of the treatments I believe may benefit you.

If you are interested in receiving a formal consultation including a diagnostic ultrasound call 847-272-8346. One of the many benefits of receiving your care at Rosen Vein Care in Northbrook,IL is that I will be directly involved with obtaining your history, physical exam and ultrasound. Not only that, but since I will be the one performing your ultrasound, I will have direct knowledge on which to base my tailored treatment plan for you.

In addition, your time is YOURS ALONE. We don’t double or triple-book appointments. My philosophy is that I want my patients (and myself) to approach the issues in a relaxed environment. I want my office to feel more like a living room than an emergency room. During treatments, I take great pains to ensure that you don’t experience great pains! Feel free to listen to music during your treatment…I do..WXRT is typically on my state-of-the-art audio system…but I’m flexible.

However, nothing pleases me more than just chatting with patients while performing their treatments. I have always enjoyed getting to know my patients, but it was always tough to do given the time constraints in practicing Internal Medicine…certainly so in Emergency Medicine. I hope that the experience you have with me at Rosen Vein Care will be as pleasant as possible. I want you to look forward to seeing me and look forward to having legs that look and feel fantastic again!

See you soon!

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