ORIGINAL ARTICLES   

Acta Phlebologica 2003 December;4(3):87-93

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: Italian

CEAP-L: proposal of a new classification of lymphedema of the limbs

Gasbarro V. ¹, Cataldi A. ²

¹ Unità Operativa di Chirurgia Vascolare, Dipartimento di Chirurgia, Anestesia e Radiologia, Arcispedale S. Anna, Università degli Studi di Ferrara, Ferrara; ² Dipartimento di Chirurgia Generale e Vascolare, Ospedale del Delta, Lagosanto, Ferrara

A meth­od to clas­sif­i­cate lym­phed­e­ma has ­been need­ed to gath­er impor­tant infor­ma­tion on the clin­i­cal evo­lu­tion of the dis­ease ­using a com­mon lan­guage and an ­easy clin­i­cal appli­cabil­ity. A pro­po­sal of a new clas­sifi­ca­tion of ­limb lym­phed­e­ma is ­inspired to ­CEAP (clas­sifi­ca­tion, eti­ol­o­gy, anat­o­my, phys­io­pa­thol­o­gy) for chron­ic ­venous insuf­fi­cien­cy of the low­er ­limb. The clas­sifi­ca­tion ­makes use of the acro­nym ­CEAP add­ing the let­ter L to under­line the ­aspect “Lymphedema”. The clas­sifi­ca­tion has ­already ­been ­appraised in 2 ­years activ­ity at the ­unit of vas­cu­lar sur­gery of Ferrara and at the ­moment it is ­under ­close exam­ina­tion by a ­group of ­work involv­ing ­many Italian sci­en­tif­ic asso­ci­a-­tions. Clinical clas­sifi­ca­tion is ­based on the ­most objec­tive ­sign in ­these ­patients, ede­ma, ­which is clas­si­fied in 5 class­es. Etiologic ­aspect con­sid­ers 2 ­types of alter­a­tions of the lym­phat­ic ­system: con­gen­i­tal and ­acquired or sec­on­dary. Anatomic ­aspect has the ­object to spec­i­fy the ana­tom­ic stuc­tures ­involved. Physiopatologi-cal ­moments are gath­ered in 5 ­groups: age­ne­sia or hypo­pla­sia (absence of lym­phat­ic ves­sels or ­scarce pres­ence), hyper­pla­sia (great­er rep­re­sen­ta­tion of lym­phat­ics): in ­this ­case a val­vu­lar ­reflux pathol­o­gy is fre­quente­ly asso­ciat­ed; obstruc­tion (by par­a­sites, ­tumors, ­after sur­gery oper­a­tions and radio­ther­a­py); ­reflux (prim­i­tive dis­ease of ­valves); over­load (­equal to dynam­ic defi­cien­cy, accord­ing to Foldi). The pro­po­sal of a new clas­sifi­ca­tion of lym­phed­e­ma ­CEAP-L ­will ­allow to ­arrange ­patients ­with a def­i­nite clas­sifi­ca­tion ­sign, ­thus creat­ing the con­di­tions for a bet­ter clin­i­cal com­par­i­son and the pos­sibil­ity to ­study ­these ­patients in ­well ­defined sta­tis­tic ­groups and not in evol­u­tive peri­ods ­that ­include ­many ­aspects ­under a sin­gle ­class.