Venous Clinical Severity Score

Prepared by Michael Ricci, MD
Corresponding chapter in Handbook of Venous Disorders: Chapters 62 and 63

Rutherford RB, Padberg FT, Comerota AJ, Kistner RL, Meissner MH, Moneta GL.Venous severity scoring: An adjunct to venous outcome assessment.  J Vasc Surg 2000;31:1307-12.

PMID: 10842165
Comment: As an adjunct to the static CEAP (Clinical-Etiology-Anatomic-Pathophysiologic) scoring system, the Ad Hoc Outcome Committee of the American Venous Forum, attempted to develop a dynamic severity score based upon the "C" of CEAP. The score allows assessment of clinical outcomes of treatment and should be used by investigators studying chronic venous conditions. Additionally, these authors attempted to develop similar systems to supplement the "P" component of the CEAP classification and the CEAP disability score: Venous Segmental Disease Score (VSDS) and the VenousDisability Score (VDS).

Meissner MH, Natiello C, Nicholls SC: Performancecharacteristics of the venous clinical severity score.  J Vasc Surg 2002;36:889-95.

PMID: 12422097
Comment: These authors attempted to validate the VCSS by direct observation of patients with chronic venous disease by multiple observers and the same observer on multiple occasions. They found that the VCSS is a very reliable and reproducible tool that
should supplement, but not replace, the CEAP classification.

Kakkos SK, Rivera MA, Matsagas MI, Lazarides MK, Robless P, Belcaro G, Geroulakos G. Validation of the new venous severity scoring system in varicose vein surgery. J Vasc Surg 2003;38:224-8.

PMID: 12891101
Comment: These authors attempted to validate the VCSS as well as the VSDS and VDS by serial assessments of patients undergoing venous surgery. Finding a high correlation between VCSS and VSDS, the authors recommended these tools for assessment of outcomes after venous surgery. 

Ricci MA, Emmerich J, Callas PW, Rosendaal FR, Stanley AC, Naud S, Vossen C, Bovill EG. Evaluating chronic venous disease with a new venous severity scoring system.  J Vasc Surg 2003;38:909-15.

PMID: 14603193
Comment: These authors also attempted to validate the VCSS, correlating it with venous duplex ultrasound, in a population at risk for venous thrombotic disease. In this case, VCSS correlated well with an abnormal ultrasound scan and, perhaps more importantly, a VCSS score of zero correlated with a normal ultrasound.

Perrin M, Dedieu F, Jessent V, Blanc M-P. Evaluation of the new severity scoring system in chronic venous disease of the lower limbs: an observational study conducted by French angiologists.  Phlebolymphology 2006;13:6-16.

In 2000, Rutherford proposed a new tool to measure the severity of venous disease. Its aim was to quantify the progression and treatment of chronic venous disease. It consists of three scores comprising clinical aspects, anatomic and pathophysiologic abnormalities (venous segmental disease score), and disability. French angiologists, in order to evaluate the relevance and usefulness of such scores in their daily practice, conducted anobservational study.

The scores were tested on 1900 patients by 398 angiologists, who completed an opinion questionnaire. In any class of the CEAP classification, the three scores were low, specifically the segmental score. Although considered as easy to grade and relevant by the majority of respondents, only a minority of angiologists, stated their intention to use these scoring parameters in everyday practice for C4-C5-C6 patients (71.8% of the 1900 patients): 42.0% for the clinical severity score, 32.9% for the segmental score, and 38.7% for the disability score. These figures were even lower for C1-C2 and C3 patients: 21.6%, 19.6%, and 26.9% respectively. The new severity scores to assess chronic venous disease seem difficult to use in daily practice, in particular the venous segmental score. They seem more appropriate to evaluate the evolution and efficacy of therapy in severe chronic venous disease.

Comment: The authors took a practical approach to test the utility of the VCSS, VSDS, and VDS scores in everyday clinical practice. Though clinicians found the VCSS and VDS relatively easy to use, the VSDS was less useful, and clinicians found the scores to not be suited to everyday clinical practice but, rather, a means to evaluate treatment modalities.