It has been developed to guide decision-making in chronic venous insufficiency evaluation and treatment.The CEAP classification for CVI is as follows:
Clinical
C0: no obvious feature of venous disease
C1: the presence of reticular or spider veins
C2: Obvious varicose veins
C3: Presence of edema but no skin changes
C4: skin discoloration, pigmentation
C5: Ulcer that has healed
C6: Acute ulcer
Etiology
Primary
Secondary (trauma, birth control pill)
Congenital (Klipper trenaunay)
No cause is known
Anatomic
Superficial
Deep
Perforator
No obvious anatomic location
Pathophysiology
Obstruction, thrombosis
Reflux
Obstruction and reflux
No venous pathology

Management
Conservative
Conservative treatment of CVI in the leg involves symptomatic treatment and efforts to prevent the condition from getting worse instead of effecting a cure. This may include

Manual compression lymphatic massage therapy
Red vine leaf extract may have a therapeutic benefit. Sequential compression pump
Ankle pump
Compression stockings
Blood pressure medicine
Hydroxyethylrutoside medication
Frequent periods of rest elevating the legs above the heart level
Tilting the bed so that the feet are above the heart. This may be achieved by using a 20 cm (7-inch) bed wedge or sleeping in a 6 degree Trendelenburg position. Surgical
Surgical treatment of CVI attempts a cure by physically changing the veins with incompetent valves. Surgical treatments for CVI include the following:

Ligation. Tying off a vein to prevent blood flow
Vein stripping. Removal of the vein. Surgical repair. Endovenous Laser Ablation
Vein transplant. Subfascial endoscopic perforator surgery. Tying off the vein with an endoscope. Valve repair (experimental)
Valve transposition (experimental)
Hemodynamic surgeries.Venous insufficiency conservative, hemodynamic and ambulatory treatment (CHIVA method) is an ultrasound guided, minimally invasive surgery strategic for the treatment of varicose veins, performed under local anaesthetic. Prognosis
CVI is not a benign disorder and, with its progression, can lead to morbidity.
Venous ulcers are common and very difficult to treat. Chronic venous ulcers are painful and debilitating. Even with treatment, recurrences are common if venous hypertension persists. Nearly 60% develop phlebitis which often progresses to deep vein thrombosis in more than 50% of patients. The venous insufficiency can also lead to severe hemorrhage. Surgery for CVI remains unsatisfactory despite the availability of numerous procedures. See also
References


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