A 2020 update on the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system and reporting standards, authored by Fedor Lurie (Jobst Vascular Institute, Toledo, USA; University of Michigan, Ann Arbor, USA) and colleagues, has been published in the Journal Vascular Surgery: Venous and Lymphatic Disorders.
Lurie et al begin by describing the CEAP classification as an internationally accepted standard for describing patients with chronic venous disorders and explain that it has been used for reporting clinical research findings in scientific journals.
They elaborate: “Developed in 1993, updated in 1996, and revised in 2004, CEAP is a classification system based on clinical manifestations of chronic venous disorders, on current understanding of the etiology, the involved anatomy, and the underlying venous pathology.”
The authors explain that, as the evidence related to these aspects of venous disorders, and specifically of chronic venous diseases (CVD, C2–C6) continue to develop, the CEAP classification needs periodic analysis and revisions.
In May 2017, the American Venous Forum (AVF) created a CEAP Task Force and charged it to critically analysis the current classification system and recommended revisions where needed.
Guided by four basic principles—preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based, and practical guidance for clinical use—the Task Force has adopted the revised Delphi process and made several changes.
These include adding Corona phlebectatica as the C4c clinical subclass, introducing the modifier “r” for recurrent varicose veins and recurrent venous ulcers, and replacing numeric descriptions of the venous segments by their common abbreviations.
The authors note that, since its initial development, the CEAP classification has been and continues to be “an important contributor to progress in the field of CVD. It has become a universally accepted standard in research and reporting.”
Although the stability of classification is “essential” for maintaining scientific and clinical advancement, “continuously accumulated evidence and knowledge require revisiting the classification and its definitions and revising them when necessary,” they remark.
Lurie et al conclude: “This 2020 CEAP revision is a result of a rigorous process of evidence analysis. Although several proposed changes were not included in the final version, proponents of these and other future potential revisions are encouraged to develop and publish supporting evidence. When such evidence is available, the AVF Task Force will revisit the CEAP classification system, making revisions as part of a continual process and maintaining the integrity of CEAP as the universally accepted classification system and reporting standard for CVD.”
In an accompanying editorial, Bo Eklöf (Lund University, Helsingborg, Sweden) lauds the “timely and warranted” revision of the 25-year old CEAP classification, noting that “reliance for too long was placed on the clinical appearance of the limb and the superficial veins, without requiring objective testing of the venous system to substantiate the diagnosis.”
He elaborates: “Previous classifications from Widmer (1978) through Miranda (1993) lacked completeness and objectivity needed for scientific accuracy.”
Focusing on the 2020 update, Eklöf comments: “The AVF Task Force, under the leadership in Fedor Lurie and Mark Passman [University of Alabama at Birmingham, Birmingham, USA], has done an excellent job with the latest, second revision and with explanation of the important role of CEAP in CVD.”
“Publication of the document appears to be a good reason to remind reviewers and editors to require the complete CEAP—basic or advanced—classification for manuscripts dealing with CVD to improve the scientific quality of published literature. By both adhering to these principles, we may be back where we were 40 years ago, using Widmer’s clinical classification.” Previously in the editorial, Eklöf remarks that Widmer’s classification (1978) “lacked completeness and objectivity needed for scientific accuracy”.