12. We recommend that all patients with venous leg ulcer be classified on the basis of venous disease classification assessment, including clinical CEAP, revised Venous Clinical Severity Score (VCCS), and venous diseasee specific quality of life assessment (Best Practice).

CEAP

• The basic CEAP classification (Table V) is a simplified version of the more comprehensive CEAP and is recommended for clinical practice.
• The Clinical class, Etiology, Anatomy, and Pathophysiology (CEAP) classification, introduced in 1994 and revised in 2004, forms the basis for CVD documentation, and should be used for all patients with chronic venous disorders.

VCSS

• In an effort to improve standardized outcome assessment of venous disease with gradable elements that can change in response to treatment, the Venous Clinical Severity Score (VCSS) was introduced in 2000 and revised in 2010 (Table VI).
• The VCSS system includes 10 clinical descriptors (pain, varicose veins, venous edema, skin pigmentation, inflammation, induration, number of active ulcers, duration of active ulceration, size of ulcer, and compressive therapy use), scored from 0 to 3 (total possible score, 30), that may be used to assess changes in response to therapy. VCSS has been shown to have minimal intraobserver and interobserver variability, and validation with objective venous parameters has been shown in a few studies. VCSS ≥8 indicates a patient with severe disease at risk for progression and warrants additional diagnostics or treatment.

Postthrombotic syndrome (PTS) Scoring System

• Of these PTS scoring systems, the Villalta score (Table VII) has the highest degree of validation and has been shown to have excellent interobserver reliability, association with ambulatory venous pressures, correlation with severity of PTS, and ability to assess change in condition over time.