“There is a way to classify the levels of severity of venous disease. And that is called a CEAP classification, CEAP. And just for general understanding, and when I restrict my description of this classification to the C bar, which is a clinical class. This clinical class divides all these patients’ varicose veins in seven different groups, C zero to C six. And I have to go from both extremes to remember myself, all the seven categories. But once I explain to you it’s going to become fairly simple. C zero is the patient with normal legs and no varicose veins. C6 is the patient with an active sore or ulcer that has been created because of the varicose veins. That’s the most extreme of this problems. So no symptoms on ulcer. And I go like this to remember: C5 is a patient who has had an ulcer by this heel now. That is C5. C1 is actually just spider veins.
You don’t see those ropey veins, oddly, in your legs. You just see these little spider veins, very millimeter or less, red like spider legs all over your legs. And that’s C1. C2 is the true varicose vein is actually there. Ropey twist and turn vein that you see fairly large in your leg. That is C2. C3 is the vertical vein that now has leg swelling because the blood, it stays there for so long. It swells up your leg. And usually this is obvious at the end of the day, cause you’ve done all your work. You’ve been on your feet. So your heart is pumping blood to your leg, but you’re not returning the blood back to your heart. So at the end of the day, you have that leg that is enormous. And then when you go back to bed and you elevate your legs, now you’re helping gravity returning the blood to your heart.
And so what happens is when the patients wake up, the legs are back to normal because they spent eight to 10 hours in bed helping the blood to go back. As soon as they put the legs down, the problem starts again. And so that was C3 and C4, which is the only one I have not described. C4 is a patient with varicose veins swelling. And those changes I described before that brown is discoloration of the skin, thickening of the skin. All these ugly changes with a very fragile skin that has a fancy term for it is called lipodermatosclerosis, which just means a hardened, fragile skin affected by varicose veins. So those are the spectrums. You can see how you can have nothing to having a venous ulcer that can be very disabling to patients. So that is the classification. And that is what allows us to determine what’s the best (?) these people. I will say that uncomplicated varicose disease is from C2 and below, meaning just by their veins and varicose veins without swelling, without anything else. Anything above C3, this has a different therapy. So from C2 and below uncomplicated varicose veins. If the patient has no many complaints, I would recommend compression stockings alone. From C3 and above, you should strongly consider doing an intervention. If compression stockings are not enough for the therapy of those people.”