Revision of the venous clinical severity score: Venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes.

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Presentation transcript:

Revision of the venous clinical severity score: Venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes Working Group Michael A. Vasquez, MD, Eberhard Rabe, Prof, Dr, Robert B. McLafferty, MD, Cynthia K. Shortell, MD, William A. Marston, MD, David Gillespie, MD, Mark H. Meissner, MD, Robert B. Rutherford, MD Journal of Vascular Surgery Volume 52, Issue 5, Pages 1387-1396 (November 2010) DOI: 10.1016/j.jvs.2010.06.161 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Corona phlebectatica. Journal of Vascular Surgery 2010 52, 1387-1396DOI: (10.1016/j.jvs.2010.06.161) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Skin pigmentation. A, Perimalleolar. B, Lower third calf. C, Above lower third calf. Journal of Vascular Surgery 2010 52, 1387-1396DOI: (10.1016/j.jvs.2010.06.161) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Inflammation. A, Cellulitis. B, Dermatitis. C, Venous eczema. Journal of Vascular Surgery 2010 52, 1387-1396DOI: (10.1016/j.jvs.2010.06.161) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Induration. A, White atrophy. B, Lipodermatosclerosis. Journal of Vascular Surgery 2010 52, 1387-1396DOI: (10.1016/j.jvs.2010.06.161) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 Number of active ulcers (remains 1 ulcer in healing phase). Journal of Vascular Surgery 2010 52, 1387-1396DOI: (10.1016/j.jvs.2010.06.161) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 6 The “visual language” of VCSS. Consistency in physician scoring and reporting allows a common language of venous disease to emerge. A, Before treatment basic clinical CEAP 3-VCSS 7. Revised VCSS scoring as follows: Pain = 1, VV = 2, Edema = 2, Pigmentation = 0, Inflammation = 0, Induration = 0, Active ulcers, size, duration = 0, Compression = 2. Total VCSS = 7. B, After treatment, scoring changes to clinical CEAP 2-VCSS 3. Pain = 0, VV = 1, Edema = 0, Pigmentation = 0, Inflammation = 0, Induration = 0, Active ulcers, size, duration = 0, Compression = 2. Total VCSS = 3.Clinical descriptorAbsent (0)Mild (1)Moderate (2)Severe (3)PainNoneOccasionalDaily not limitingDaily limitingVaricose veinsNoneFewCalf or thighCalf and thighVenous edemaNoneFoot and ankleBelow kneeKnee and aboveSkin pigmentationNoneLimited perimalleolarDiffuse lower 1/3 calfWider above lower 1/3 calfInflammationNoneLimited perimalleolarDiffuse lower 1/3 calfWider above lower 1/3 calfIndurationNoneLimited perimalleolarDiffuse lower 1/3 calfWider above lower 1/3 calfNo. active ulcersNone123 or moreUlcer durationNone<3 mo3-12 mo>1 yActive ulcer sizeNone<2 cm2-6 cm>6 cmCompression therapyNoneIntermittentMost daysFully comply Journal of Vascular Surgery 2010 52, 1387-1396DOI: (10.1016/j.jvs.2010.06.161) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 7 A, Before treatment clinical C4 -VCSS 16. Pain = 2, VV = 1, Edema = 2, Pigmentation = 3, Inflammation = 3, Induration = 3, Active ulcers, size, duration = 0, Compression = 2. Total VCSS = 16. B, Four months after treatment, patient remains clinical C4, but C4-V9. Pain = 0, VV = 1, Edema = 1, Pigmentation = 3, Inflammation = 0, Induration = 2, Active ulcers, size, duration = 0, Compression = 2. Total VCSS = 9. Journal of Vascular Surgery 2010 52, 1387-1396DOI: (10.1016/j.jvs.2010.06.161) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 8 A, Prior to treatment, clinical C6-V18. Pain = 3, VV = 3, Edema = 2, Pigmentation = 3, Inflammation = 1, Induration = 2, Active ulcers = 1, size = 1, duration = 1, Compression = 1. Total VCSS = 18. B, One month after treatment, clinical C5-V11. Pain = 1, VV = 2, Edema = 1, Pigmentation = 3, Inflammation = 0, Induration = 2, Active ulcers = 0, size = 0, duration = 0, Compression = 2. Total VCSS = 11. Journal of Vascular Surgery 2010 52, 1387-1396DOI: (10.1016/j.jvs.2010.06.161) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 9 The broadened language of uniting CEAP with VCSS in CVD. More information is relayed in stating C6-V25 changes to C6-V21 and at last C5-V7. A, Pre – Pain = 3, VV = 3, Edema = 2, Pigmentation = 2, Inflammation = 3, Induration = 2, Active ulcers = 1, size = 3, duration = 3, Compression = 3. Total VCSS = 25. B, 1 week post – Pain = 2, VV = 2, Edema = 1, Pigmentation = 2, Inflammation = 2, Induration = 2, Active ulcers = 1, size = 3, duration = 3, Compression = 3. Total VCSS = 21. C, 2 months post – Pain = 0, VV = 1, Edema = 0, Pigmentation = 2, Inflammation = 0, Induration = 2, Active ulcers = 0, size = 0, duration = 0, Compression = 2. Total VCSS = 7. Journal of Vascular Surgery 2010 52, 1387-1396DOI: (10.1016/j.jvs.2010.06.161) Copyright © 2010 Society for Vascular Surgery Terms and Conditions