The "C" of CEAP: suggested definitions and refinements: an International Union of Phlebology conference of experts.

The field of chronic venous disease (CVD) has suffered from a lack of precision in diagnosis. This deficiency has led to conflicting reports in studies of management of specific venous problems. It is believed that these conflicts would be resolved with precise pretreatment diagnosis and classification of each affected limb. Adoption of a single classification worldwide would facilitate meaningful communication about CVD and serve as a basis for a more scientific analysis of management alternatives. In February 1994, these problems were addressed by an international ad hoc committee of the American Venous Forum at a meeting organized by the Straub Foundation in Maui, Hawaii. This committee under the chairmanship of Andrew Nicolaı̈des produced a consensus document for classification and grading of CVD on the basis of clinical manifestations (C), etiologic factors (E), anatomic distribution of involvement (A), and underlying pathophysiologic findings (P), the CEAP classification. The purpose was to provide a comprehensive objective classification that could be used worldwide. The CEAP system was published in 25 journals and books in eight languages (Table II). Today, most published papers in phlebology use portions of the CEAP classification. The authors of this classification understood that it needed to be augmented and changed as new knowledge in phlebology appeared. In 2000, two developments of the CEAP system were published. An ad hoc committee of the American Venous Forum presented a new venous severity scoring system, and an international consensus conference in Paris suggested a new classification for recurrent varicose veins after surgery. On a French initiative, the European Phlebological File was created where 49 angiologists from nine European countries entered exhaustive data from 872 patients. The external consistency of the clinical classification “C” was good and the internal consistency was poor. The French team has also studied the reproducibility of the C classes and found that the intraobserver reproducibility was good (85%) and the interobserver reproducibility was poor (47%). A conference of experts on refinement of “C” in CEAP was organized at the 14th World Congress of the International Union of Phlebology (IUP) in Rome, September 2001.