The venous insufficiency pictures below are intended to aid in understanding the clinical evaluation of venous disease. There are several scoring systems physicians use to grade venous insufficiency. One of the most commonly used system is the CEAP classification. The C in the CEAP classification stands for clinical. What do the patients veins look like? E stands for etiology. What is the cause of the vein disease? A stands for anatomy. Which veins are involved? And finally, P stands for pathophysiology. Is the vein problem secondary to blockages or abnormal valves and reflux. Here is a picture guide to clinical section of the CEAP classification for venous insufficiency. All the following pictures are from patients seen at Lakeshore Veins, a varicose vein clinic in Mequon, Wisconsin
Images of Venous Insufficiency Stages
As venous insufficiency progresses, swelling is seen. Swelling usually starts at the ankle but can include the entire leg. In this patient, note the varicose veins in the calf. Also, there is leg swelling with sock lines seen at the ankle and the knee. Classically, leg swelling caused by venous insufficiency is worse at the end of the day and better in the morning. Additionally, leg swelling can be worse after travel. Both conservative care including use of graduated compression stocking as well as treating the underlying venous insufficiency can help with leg swelling.
As venous insufficiency progresses further, the skin becomes affected. Note the slight brown discoloration around the ankle and lower leg. This brown discoloration is a very early sign of skin changes. The distended veins leak slightly and the hemosiderin in the blood stains the skin. The skin staining is usually permanent.