Summary of diagnostic and characteristic parameters of C0 to C2 patients based on the CEAP2020 classification

Hemodynamic changes in C0 to C2 according to the clinical/etiological/anatomical/pathophysiological classification have not been analyzed extensively. We intend to investigate the characteristics of early stage venous disease using venous clinical severity score (VCSS), heaviness/ache/swelling/throbbing/itching (HASTI) score and duplex ultrasound (DUS) derived parameters. From Aug. 2020 to Jul. 2021, consecutive patients were categorized according to the clinical/etiological/anatomical/pathophysiological 2020 classification. The vein diameter (mm), reflux time (s), cross-sectional area (cm2), peak and mean reflux velocity (cm/s), and total reflux volume (mL) were documented in the superficial system and deep system. VCSS and HASTI scores were assessed and DUS parameters were analyzed. A P value of less than .05 was considered statistically significant. We studied 257 consecutive patients (142 female) with 371 limbs. The mean age was 50.96 ± 13.27 years (range, 20-81 years; median, 53 years) with an average body mass index of 24.03 ± 2.96 kg/m2 (range, 17.00-33.06 kg/m2; median, 23.67 kg/m2). The proportion of clinical (C) category was as followed: 47 C0S (12.67%), 45 C1 (12.13%), and 279 C2 (75.20%). There were 42.6% of C0 and 62.2% of C1 associated with some form of venous reflux, Pr (pathology [P]-reflux). Reflux of the great saphenous vein above the knee (GSVa) was the most commonly affected vein segment from C0-2. C1 differed from C0 only by age and severity scores with a cut-off value of 1 for both VCSS and HASTI. Larger saphenous veins diameter (GSV and small saphenous vein) were seen in Pr (P-reflux) than Pn (P-none) of C0 cases. Larger deep vein diameters (common femoral vein, femoral vein, and popliteal vein) were evident in Pr versus Pn of C1 cases. In C2, the popliteal vein, saphenofemoral junction, and GSVa were dilated in Pr cases. Both HASTI and VCSS were discriminative from C0 to C2. C0 differed from C1 by age and severity scores as DUS characteristics were not significantly different between the two groups. Vessel diameter played a discriminative role in distinguishing Pn versus Pr cases in each C0-2 category. GSVa was the most frequent reflux segment irrespective of reflux types.