Vein Specialists speak in a lingo to grade the clinical severity of vein sufferers. This classification system is termed the CEAP system. When discussing with our vein colleagues or to define severity of a person’s vein disease, really only the “C” of CEAP is relevant. “C” severity ranges from 0-6 (least to worst):
C0: No evidence visible or sonographically of lower extremity vein disease
C1: very superficial venous disease in reticular veins and/or resulting spider veins
Typically C1 disease, although sometimes causing pain symptoms (usually burning/stinging), is not medically relevant (i.e. insurers only consider this cosmetic and will not cover treatment). Some patients inherit genetics for C1 disease but never progress further.
C2: superficial vein trunk insufficiency with/without visible varicose vein branches (this would be confirmed by sonogram
C3: C2 with chronicity to result in daily swelling of the affected lower extremity (ies)
C4: C3 status with swelling chronic and unrelenting enough to cause unhealthy non-clearing impurity build-up in the lower leg skin to cause skin irritation, rash, thinning, or permanent skin hyper- or hypo-pigmentation
C5: C4 disease advanced to have caused at least one lower leg skin ulceration (healed)
C6: C4 disease causing initial or recurrent active lower leg skin ulceration. Any active skin ulceration is at risk of skin infection; at worst is at risk of non-healing that is limb or life-threatening
Clinically speaking, most patients begin having symptoms of vague pain—usually daily heavy/tired sensations of the affected extremity(ies)—when C2 stage achieved. Sometimes during C2 stage, there is no visible varicosed branch vein(s) to confirm the venous problem. As patients progress in to stage C3, the symptoms typically esclalate with obvious swelling, more prominent in the afternoon/evening hours while up against gravity during the day. Pain intensifies in each stage progression, and amazingly, a small subset of patients who progress in to stages C2 – C6 never show any branch vein varicosed veins. Yet, a culprit trunk vein is causative below the surface and is only detected with duplex venous ultrasound. Such patients can complain for years and be mis-diagnosed. It takes a high level suspicion on the part of such a patients primary care provider, or a savvy patient reading this website, to call and schedule a simple in-office consultation to rule in/out.
If you have any pain and/or swelling in your lower extremity(ies) on a consistent basis, even without visible varicose veins (meaning you are clinically classified as C0 or C1), you are never wrong to schedule a consultation including standing venous ultrasound. Insurers will cover this initial consultation. 10-15% of the population who undergo such evaluations have occult venous disease amenable to minor-surgical non-hospital curative procedures that insurance will cover in most cases.