Venous Leg Disease

CLASSIFICATION

CEAP Classification

• C1 = Telangiectasias or reticular veins

• C2 = Varicose veins (>3 mm)

• C3 = Edema

• C4 = Pigmentation, eczema

• C4b = Lipodermatosclerosis, atrophie blanche

• C5 = Healed venous ulcer

• C6 = Active venous ulcer

🔍 Use this to guide urgency and referral decisions

TREATMENT (based on 40172896)

Asymptomatic Telangiectasias or Reticular Veins

• DO NOT order duplex ultrasound

• Treatment (conservative):

  • Leg elevation, weight control

  • Avoid prolonged standing

  • Graduated compression stockings (knee-high, 20–30 mmHg)

• Reassure: These don’t progress to severe disease without symptoms.

Symptomatic: Pain, Swelling, Heaviness, Night Cramps

• Initiate:

  • Compression stockings (note: low adherence common)

  • OTC supplements:

    • Micronized purified flavonoid fraction (MPFF) 500 mg/day (25972136)

    • Ruscus extract (e.g., Vasculera) (22801396)

  • Topical corticosteroids or calcineurin inhibitors if eczema is present

Referral for the following:

• Persistent symptoms despite above: refer to vascular for duplex ultrasound

• C2–C6 findings: duplex required to assess for reflux

• Signs of ulceration or lipodermatosclerosis: referral to vein specialist or wound care (if not comfortable with wound care management as a dermatologist - some are, some aren't)

• Cosmetic concern but symptomatic C1Refer for sclerotherapy or laser

Specialist Treatment Pathways (know what they may get)

• C1 with symptoms: sclerotherapy (foam or liquid), laser

• C2–C4 with reflux: endovenous ablation (laser/RF) preferred over ligation/stripping

• C5–C6: multidisciplinary wound care, endovenous intervention, compression

​