GPAtlas🧭 When to suspect
Suspect chronic venous disease in any patient with the symptoms and signs of sustained venous hypertension in the legs. The clinical spectrum runs from visible varicose veins and aching, heavy legs through dependent oedema and skin changes (venous eczema, haemosiderin staining, lipodermatosclerosis) to frank venous ulceration, classically over the medial malleolus – the gaiter area. Disease is diagnosed clinically; duplex ultrasound is a specialist investigation that maps reflux for treatment planning, not a primary-care screening test.
The two jobs in primary care are simple: recognise the venous pattern and refer appropriately, and exclude the dangerous mimics – deep vein thrombosis, an arterial or mixed ulcer, and an underlying abdominopelvic cause. Suspect abdominopelvic venous disease where there is lower-limb incompetence with recurrent DVT, or pelvic congestion (chronic pelvic pain, or left flank pain with haematuria).
| CEAP clinical class | What you see |
|---|---|
| C0–C1 | No visible disease (C0), or telangiectasia / reticular veins (C1) |
| C2 | Varicose veins (≥ 3 mm on standing) |
| C3 | Venous oedema |
| C4 | Skin changes – pigmentation / venous eczema (C4a); lipodermatosclerosis / atrophie blanche (C4b) |
| C5 | Healed venous ulcer |
| C6 | Active venous ulcer |
CEAP is a useful shared vocabulary for documenting severity, but note that NICE does not use CEAP stage as the basis for referral – referral is driven by the clinical criteria below (symptoms, skin changes, thrombosis, ulceration, bleeding).
Source: NICE CG168
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.