Performance of an adjustable compression wrap in occupational leg swelling.

BACKGROUND: Edema in some subjects worsens over time and wraps help to reduce the leg volume. MATERIAL AND METHODS: An adjustable compression wrap was tried on volunteers for 5 h and volumes measured in each limb before and after wrapping using a 3D surface scanner (HandySCAN 3D®) to estimate the volume of the leg. The contralateral leg was used as control. RESULTS: We observed a significant decrease in volume in the wrap legs and an increase in the control legs (p < .001), both in the lower part of leg (p = .001) and in the upper part (p = .001). CONCLUSIONS: Using the Readywrap® for 5 hours significantly reduces the leg volume. This study enables Readywrap to be studied in a population that is easy to observe in the context of a research program. The Handyscan3D® was shown accurate and reproducible to assess leg volume in future studies.

The Use of 3D Printed Models for Surgical Simulation of Cranioplasty in Craniosynostosis as Training and Education.

BACKGROUND: The advance in imaging techniques is useful for 3D models and printing leading to a real revolution in many surgical specialties, in particular, neurosurgery. METHODS: We report on a clinical study on the use of 3D printed models to perform cranioplasty in patients with craniosynostosis. The participants were recruited from various medical institutions and were divided into two groups: Group A (n = 5) received traditional surgical education (including cadaveric specimens) but without using 3D printed models, while Group B (n = 5) received training using 3D printed models. RESULTS: Group B surgeons had the opportunity to plan different techniques and to simulate the cranioplasty. Group B surgeons reported that models provided a realistic and controlled environment for practicing surgical techniques, allowed for repetitive practice, and helped in visualizing the anatomy and pathology of craniosynostosis. CONCLUSION: 3D printed models can provide a realistic and controlled environment for neurosurgeons to develop their surgical skills in a safe and efficient manner. The ability to practice on 3D printed models before performing the actual surgery on patients may potentially improve the surgeons' confidence and competence in performing complex craniosynostosis surgeries.

Adjustable compression wraps: stretch, interface pressures and static stiffness indices.

BACKGROUND: Adjustable compression wraps (ACWs) may represent the future of compression for the treatment of the most severe stages of chronic venous diseases and lymphedema. We tested in five healthy subjects: Coolflex® from Sigvaris®; Juzo wrap 6000®, Readywrap® from Lohmann Rauscher®; Juxtafit® and Juxtalite® from Medi®, Compreflex® from Sigvaris®. The objective of this pilot study was to study the stretch, interface pressures, and Static Stiffness Index (SSI) of the six ACWs applied to the leg. METHODS: The stretch was evaluated by stretching the ACWs to their maximum length. Interface pressure measurements were performed using a PicoPress® transducer and a probe placed at point B1. Interface pressures were measured in the supine resting position and in the standing position. We calculated the SSI. We started the measurements at 20 mmHg in the supine position and increased the pressures by 5 mmHg to 5 mmHg. RESULTS: Coolflex® (inelastic ACW) cannot exceed a maximum pressure of 30 mmHg at rest with a maximum SSI of approximately 30 mmHg. Juzo wrap 6000® (a 50% stretch) and Readywrap® (a 60% stretch) have a profile of stiffness very near one to the other. The optimal stiffness for Juzo is from 16 mmHg to of 30 mmHg for a resting pressure between 25 mmHg and 40 mmHg. For Readywrap, the optimal stiffness is from 17 mmHg to 30 mmHg with a maximum SSI of 35mmHg. The optimal application zone of this wrap at rest is 30 to 45 mmHg. Juxtafit®, Juxtalite® and Compreflex® (respectively 70%, 80%, 124% stretch) can be applied with pressures above 60 mmHg but with maximum SSI of 20 mmHg for Circaid® and>30 mmHg for Compreflex®. CONCLUSIONS: This pilot study allows us to propose a classification of wraps according to their stretch: inelastic ACW and short or long stretch ACW (50-60% and 70%, 80%, and 124% stretch). Their stretch and stiffness could help to better determine what could be expected of ACWs in clinical practice.

Anatomical Variations of the Median Nerve: A Cadaveric Study.

OBJECTIVES: Variations in the morphological anatomy of the median nerve such as formation, distribution, and communication have been well documented. All these variations should be taken into account when practicing any surgical approach for the treatment of injuries affecting the median nerve. Furthermore, they are of the utmost importance for interpretation of the clinical presentation. METHODS: The objective of this investigation was to determine the anatomical variations in the formation of the median nerve in cadavers at the Forensic Pathology department in Central Clinical Hospital of the Academy of Sciences of the Russian Federation between January 2022 and April 2022. A descriptive, cross-sectional, and prospective information source study was conducted on 42 anatomical bodies (corpses) and 84 brachial plexuses. RESULTS: After analyzing the results obtained in this investigation, we concluded that the median nerve presented variation in its formation in 22.6% of the investigated cases. These variations were more common in males (81.8%) than females (18.2%). The anatomical variation was unilateral in 7.1% and bilateral in 19% of all anatomical bodies examined. CONCLUSIONS: The median nerve presented a great number of variations in its formation in roughly 23% of the anatomical bodies, with male being the predominant gender. Furthermore, the most frequent region of formation was the axillary region (92.9%). For clinicians, it is important to remember these variations during surgical procedures in this area and during brachial plexus block.

Limitations to self-management of adjustable compression wraps in the elderly: results of a prospective cohort study.

BACKGROUND: Adjustable compression wraps are used for treating lymphedema and chronic venous insufficiency. These diseases often affect elderly patients with associated pathologies or other limiting factors. These can prevent the self-application of the device by patients on themselves. A better understanding of these factors or the associated pathology in the elderly is important before prescribing or not prescribing a wrap. METHODS: The objective of this prospective cohort study was to determine the main factors that prevent the self-application of the device (Circaid Juxtalite, Medi Italia S.r.l., Bologna, Italy) to the lower limb in the elderly. A private nurse selected the first 30 retired subjects over 65 years of age seen at home for routine nursing care. After a demonstration, she asked them to put on the wrap to reach a pressure of 40 mmHg in the calf (point B1). She recorded the pressures as the subjects applied the wrap twice in a row. The next day, the subject repeated the application of the wrap twice. We considered that an average pressure of more than 30 mmHg is recommended to treat venous edema or ulceration. RESULTS: Thirty percent of the subjects put on the wrap by themselves with an average pressure of at least 30 mmHg. Age is not a limiting factor. Obesity, gripping difficulties, cognitive impairment and low social status seem to be factors limiting the daily self-management of an adjustable compression wrap in the elderly. CONCLUSIONS: The self-management of adjustable compression wraps in the elderly person encounters obstacles that need to be known. The investigation has revealed that obesity, gripping difficulties, cognitive impairment and low social status are limiting factors. Age was not shown to be a limiting obstacle.

Feasibility of a fetal anatomy 3D atlas by computer-assisted anatomic dissection.

OBJECTIVE: To assess the feasibility of 3D modelisation of fetal anatomy by using the Computer-assisted anatomic dissection (CAAD) based on immunolabeled histologic slices and MRI slices with a specific 3D software. STUDY DESIGN: For pelvis and lower limbs, subjects came from legal abortion, medical pregnancy termination, or late miscarriage. Specimens were fixed in 10 % formalin, then embedded in paraffin wax and serially sectioned. The histological slices were stained using HES and Masson Trichrome. Protein S-100 and D2-40 markers were used for immuno-labelling. Serial transverse sections were digitalized and manually aligned. Fetal brain slices were obtained from in utero or post-mortem MRI. RESULTS: CAAD was performed on 10 fetuses: pelvis was modelised with 3 fetuses of 13, 15 and 24 W G, lower limbs with 2 fetuses of 14 and 15 W G and brain with 5 fetuses aged between 19 and 37 W G. Fetal pelvis innervation was analysed after immunolabelling and nerves appeared proportionally bigger than in adults with the same topography. Lower limbs analysis revealed that nerve development was guided by vascular development: the sciatic nerve along the big axial vein, the saphen nerve along the big saphen vein and the sural nerve along the small saphen vein. Fetal brain study allowed to describe the gyration process and the lateral ventricle development. CONCLUSION: CAAD technique provides an accurate 3D reconstruction of fetal anatomy for lower limbs and pelvis but has to be improved for brain model since midline structures were not amendable for analysis. These results need to be confirmed with larger series of specimens at different stages of development.

The 2020 update of the CEAP classification system and reporting standards.

The CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification is an internationally accepted standard for describing patients with chronic venous disorders and it has been used for reporting clinical research findings in scientific journals. Developed in 1993, updated in 1996, and revised in 2004, CEAP is a classification system based on clinical manifestations of chronic venous disorders, on current understanding of the etiology, the involved anatomy, and the underlying venous pathology. As the evidence related to these aspects of venous disorders, and specifically of chronic venous diseases (CVD, C2-C6) continue to develop, the CEAP classification needs periodic analysis and revisions. In May of 2017, the American Venous Forum created a CEAP Task Force and charged it to critically analyze the current classification system and recommend revisions, where needed. Guided by four basic principles (preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based, and practical for clinical use), the Task Force has adopted the revised Delphi process and made several changes. These changes include adding Corona phlebectatica as the C4c clinical subclass, introducing the modifier "r" for recurrent varicose veins and recurrent venous ulcers, and replacing numeric descriptions of the venous segments by their common abbreviations. This report describes all these revisions and the rationale for making these changes.

Modelado vectorial tridimensional del corazón y los vasos coronarios a partir de cortes anatómicos del proyecto Korean Visible Human / Visible Human Project: a new computarized virtual dissection table as a learning tool for students and anatomy teachers

La disección virtual es una herramienta educativa sumamente valiosa en anatomía. Es particularmente útil cuando hay escasez de cadáveres o en los casos en que la disección no sea posible por motivos religiosos o éticos. En este trabajo los autores presentan una reconstrucción 3D de un corazón masculino a partir de la información del proyecto Korean Visible Human, realizado en el marco de asociaciones de la cátedra de anatomía digital de la UNESCO creada recientemente en la Universidad Descartes. La segmentación manual de 1640 cortes anatómicos se logró a través del software Winsurf, produciendo un modelo vectorial 3D interactivo del corazón y la anatomía que lo rodea. Se reconstruyeron ochenta y cuatro estructuras, incluyendo el corazón y sus vasos (27 estructuras), tráquea, esófago, pulmones, cayado aórtico, vena cava inferior, riñones, sistema esquelético conformado por 58 estructuras, entre ellas: esternón, cartílagos costales, vértebras torácicas y discos intervertebrales, sacro, coxales y piel. El modelo vectorial 3D obtenido se exportó en formato PDF 3D produciendo una verdadera herramienta de disección virtual a través de la interfaz de Acrobat: las estructuras anatómicas pueden individualizarse y manipularse interactivamente como 84 objetos 3D separados. Además, se pueden agregar "etiquetas" con el nombre de cada elemento anatómico. Esta nueva mesa de disección virtual computarizada es una herramienta simple y poderosa tanto para alumnos como para docentes de anatomía. Además, resulta ser la base para futuras herramientas de simulación que contribuirán al entrenamiento de cirujanos

The virtual dissection is a remarkable learning tool in anatomy. It is particularly useful in the case of lack of cadavers or if anatomical dissection is impossible due to ethical or religious reasons. The authors present here a 3D reconstruction of the female's heart from the Visible Korean human data, made in the frame of the projects of the UNESCO chair of digital anatomy created recently at the Descartes University.The manual segmentation of 1640 anatomical slices was achieved with the Winsurf ® software producing an interactive 3D vectorial model of the heart and surrounding anatomy. Eighty four anatomical structures were reconstructed, including the heart and its vessels (27 structures), trachea, oesophagus, lungs, aortic arch, superior vena cava, azygos system, inferior vena cava, right and left kidneys, skeletal system (58) structures including: sternum, xiphoid process, clavicles, ribs, costal cartilage, thoracic vertebrae, intervertebrales discs, sacrum, hip bones, and femurs) and skin. The obtained 3D vectorial model was exported in 3D PDF format, producing a true virtual dissection tool through the Acrobat's interface: the anatomical structures can be individually and interactively manipulated as 84 separated 3D objects. 3D labels can be added with the name of each anatomical element. This new computerized virtual dissection table is a simple and powerful learning tool for students and anatomy teachers. It is also the basis of future simulation tools for surgeon's training

Three-Dimensional Modelization of the Female Human Inferior Hypogastric Plexus: Implications for Nerve-Sparing Radical Hysterectomy.

BACKGROUND/AIMS: This study aims to describe the autonomic nervous network of the female pelvis with a 3D model and to provide a safe plane of dissection during radical hysterectomy for cervical cancer. METHODS: Pelvises of 3 human female fetuses were studied by using the computer-assisted anatomic dissection. RESULTS: The superior hypogastric plexus (SHP) was located at the level of the aortic bifurcation in front of the sacral promontory and divided inferiorly and laterally into 2 hypogastric nerves (HN). HN ran postero-medially to the ureter and in the lateral part of the uterosacral ligament until the superior angle of the inferior hypogastric plexus (IHP). IHP extended from the anterolateral face of the rectum, laterally to the cervix and attempted to the base of the bladder. Vesical efferences merged from the crossing point of the ureter and the uterine artery and ran through the posterior layer of the vesico-uterine ligament. CONCLUSIONS: The SHP could be injured during paraaortic lymphadenectomy. Following the ureter and resecting the medial fibrous part of the uterosacral ligament may spare the HN. No dissection should be performed under the crossing point of the ureter and the uterine artery.

Treatment protocol on stasis edema in poorly mobile nursing home patients.

BACKGROUND: Prolonged immobility in the sitting position in the elderly is known to produce venous stasis with leg edema and possible skin changes. METHODS: The authors have tested a treatment protocol in 30 patients to quantify the reduction of volume caused by an adjustable compression Velcro® wrap (Circaid Juxtalite®, medi GmbH, Bayreuth, Germany) after 15 days and to compare its effect on the leg volume for the next 15 days with 15- to 20-mmHg compression stockings (CS). RESULTS: The authors noted a volume decrease between T0 and T15 by 10.8% (52 legs) under Circaid Juxtalite®. At T30, they observed a non-significant difference between Circaid Juxtalite® (-1%) and the CS (1.3%). CONCLUSIONS: A Velcro® adjustable compression wrap (Circaid Juxtalite®) is efficient in reducing stasis edema in the elderly. Stabilization of the leg volume with the use of 15-20 mmHg CS suggests that a high pressure to maintain results is not required to maintain results.

Evaluation of three different devices to reduce stasis edema in poorly mobile nursing home patients.

BACKGROUND: Prolonged immobility in the sitting position in the elderly is known to produce venous stasis with leg edema and possible skin changes. Compression stockings are often applied for this clinical problem. There is few experienced nursing staff available to supervise the difficult task of stocking application. METHODS: The authors have researched other effective and simple devices that may be suitable alternatives. This article reports the results of three different devices to reduce leg edema, as measured by reduction in leg volume: an electro-stimulation device, an adjustable compression Velcro® wrap and a short stretch bandage, each tested over a two-hour period. RESULTS: In this randomized pilot study including 38 patients, the authors observed no difference in leg volume following electro-stimulation (Veinoplus®). They noted a significant reduction in leg volume following use of the other two devices, more with the adjustable Velcro® wrap compression (Circaid Juxtafit®) than with the short stretch bandage (Rosidal K®). Measurement of the interface pressures created by these two devices and also assessing the stiffness created by applying each device for two hours confirm that pressure is more important than stiffness in the reduction of edema in these particular patients. CONCLUSIONS: This pilot study is to be added to the results of previous published studies showing the efficacy in reducing leg edema of Velcro® adjustable compression wrap and its ease of use.

Prospective randomized controlled study of patient compliance in using a compression stocking: Importance of recommendations of the practitioner as a factor for better compliance.

Background Patient compliance is the cornerstone of compression therapy success. However, there has been up to now no tool to assess it other than self-reporting by the patient, which is not reliable. Material and methods Forty active females classified C2S were enrolled to wear compression stockings (CS) providing a pressure of 15-20 mmHg at the ankle. A thermal probe was inserted in the stocking (Thermotrack®), recording the skin temperature every 20 min for four weeks. The patients were randomized in two groups of 20: - Group 1: Receiving minimal recommendations by their physician at the office. - Group 2: Receiving in-depth recommendations by the physician reinforced with SMS message which were repeated once a week for four weeks. The basic CEAP classification and the quality of life (QoL) were recorded before and after four weeks. Results The two groups are similar for age, symptoms and type of CS. The analysis of the thermal curves showed a significant increase (+33%) in the average wearing time daily in the group 2: 8 h vs. 5.6 h (group1) p < 0.01. The average number of days worn per week is also increased: 3.4 (group 1) vs. 4.8 (group 2), thus improving patient compliance from 48.5% to 70% as a direct result of the physician recommendations ( p < 0.001). Conclusion This is the first study assessing the real compliance in CVD patients of using compression. It shows that better and repeated recommendations by the practitioner result in an increase in time the compression is used by 33%. The study also suggests that the number of days the compression stocking is worn is a good criterion of patient compliance.

Anatomy of the lymph node venous networks of the groin and their investigation by ultrasonography.

OBJECTIVE: To describe the anatomy of the lymph node venous networks of the groin and their assessment by ultrasonography. MATERIAL AND METHODS: Anatomical dissection of 400 limbs in 200 fresh cadavers following latex injection as well as analysis of 100 CT venograms. Routine ultrasound examinations were done in patients with chronic venous disease. RESULTS: Lymph node venous networks were found in either normal subjects or chronic venous disease patients with no history of operation. These networks have three main characteristics: they cross the nodes, are connected to the femoral vein by direct perforators, and join the great saphenous vein and/or anterior accessory great saphenous vein. After groin surgery, lymph node venous networks are commonly seen as a dilated and refluxing network with a dystrophic aspect. We found dilated lymph node venous networks in about 15% of the dissected cadavers. CONCLUSION: It is likely that lymph node venous networks represent remodeling and dystrophic changes of a normal pre-existing network rather than neovessels related to angiogenic factors that occur as a result of an inflammatory response to surgery. The so-called neovascularization after surgery could, in a number of cases, actually be the onset of dystrophic lymph node venous networks.Lymph node venous networks are an ever-present anatomical finding in the groin area. Their dilatation as well as the presence of reflux should be ruled out by US examination of the venous system as they represent a contraindication to a groin approach, particularly in recurrent varicose veins after surgery patients. A refluxing lymph node venous network should be treated by echo-guided foam injection.

Compression versus inner sole for venous patients with foot static disorders: a prospective trial comparing symptoms and quality of life.

OBJECTIVE: To prospectively compare the improvement in quality of life and symptoms achieved when using two treatments-medical compression stockings and inner sole-in subjects with symptomatic chronic venous disease in the presence of foot static disorders. MATERIALS AND METHODS: This prospective study included 24 patients with a symptomatic chronic venous disease associated with foot static disorders. The basic CEAP was used to classify the patients. The venous symptoms were recorded using a 10-point visual analog scale and scored using a customized questionnaire. Patient-reported quality of life data were acquired using a CIVIC questionnaire. A standardized measurement of the Djian-Annonier angle was used to quantify the foot static disorders. We compared the use of the following two treatments: medical compression stockings (18 mm of Hg) and inner sole. For this comparison, we used a crossover technique over 4 successive weeks. RESULTS: One male and 23 female patients were included in this study. We found significant improvement in quality of life scores when only medical compression stockings were used (p < 0.005), only inner sole were used (p < 0.01) and also when both treatments were used together (p < 0.001), compared with no treatment. This was mainly observed for the somatic component of CIVIC. The symptoms of pain, heaviness, swollen feeling, and cramps were significantly improved by the two treatments, whether given separately (p < 0.001) or together (p < 0.0001). No additive effect of the treatments was observed. CONCLUSION: This study suggests that a number of leg symptoms occurring in varicose veins patients are not likely to have a venous origin. They are frequently related to a foot static disorder, which is responsible for postural changes. This study also strongly demonstrates the need for correction of the foot static disorder if such a disorder is present in any patient with chronic venous disease. The use of the inner sole will improve the symptoms and also the quality of life with an efficiency that is almost equal to that provided by the medical compression stockings and the combined use of both treatments is recommended.

Anatomy of the veno-muscular pumps of the lower limb.

OBJECTIVE: To study the anatomy of the veno-muscular pumps of the lower limb, particularly the calf pump, the most powerful of the lower limb, and to confirm its crucial importance in venous return. METHODS: In all, 400 cadaveric limbs were injected with green Neoprene latex followed by an anatomical dissection. RESULTS: The foot pump is the starter of the venous return. The calf pump can be divided into two anatomical parts: the leg pump located in the veins of the soleus muscle and the popliteal pump ending in the popliteal vein with the unique above-knee collector of the medial gastrocnemial veins. At the leg level, the lateral veins of the soleus are the bigger ones. They drain vertically into the fibular veins. The medial veins of the soleus, smaller, join the posterior tibial veins horizontally. At the popliteal level, medial gastrocnemial veins are the largest veins, which end uniquely as a large collector into the popliteal vein above the knee joint. This explains the power of the gastrocnemial pump: during walking, the high speed of the blood ejection during each muscular systole acts like a nozzle creating a powerful jet into the popliteal vein. This also explains the aspiration (Venturi) effect on the deep veins below. Finally, the thigh pump of the semimembranosus muscles pushes the blood of the deep femoral vein together with the quadriceps veins into the common femoral vein. CONCLUSION: The veno-muscular pumps of the lower limb create a chain of events by their successive activation during walking. They play the role of a peripheral heart, which combined with venous valves serve to avoid gravitational reflux during muscular diastole. A stiffness of the ankle or/and the dispersion of the collectors inside the gastrocnemius could impair this powerful pump and so worsen venous return, causing development of severe chronic venous insufficiency.

Anatomy and embryology of the small saphenous vein: nerve relationships and implications for treatment.

The aim of this paper is to describe the anatomical relations of the small saphenous vein (SSV) in order to define the high-risk zones for the treatment of chronic venous disease. The SSV runs in the saphenous compartment demarcated by two fascia layers: a muscular fascia and a membranous layer of subcutaneous tissue. The clinician should be keenly aware of the anatomical pitfalls related to the close proximity of nerves to the SSV in order to avoid their injury: At the ankle, the origin of the SSV is often plexiform, located deep below the fascia, and the nerve is really stuck to the vein. The apex of the calf is an area of high risk due to the confluence of nerves which perforate the aponeurosis. Moreover, the possible existence of a 'short saphenous artery' which poses a high risk for injection of a sclerosing agent due to a highly variable disposition of this artery surrounding the SSV trunk. For this reason, procedures under echo guidance in this area are mandatory. The popliteal fossa is probably a higher risk zone due to the vicinity of the nerves: the small saphenous arch is close to the tibial nerve, or sometimes the nerve of the medial head of the gastrocnemius muscle. In conclusion, before foam injection or surgery, a triple mapping of the small saphenous territory is mandatory: venous haemodynamical mapping verifying the anatomy that is highly variable, nerve mapping to avoid trauma of the nerves and arterial mapping. This anatomical study will help to define the main high-risk zones.

Dogmas and controversies in compression therapy: report of an International Compression Club (ICC) meeting, Brussels, May 2011.

The International Compression Club (ICC) is a partnership between academics, clinicians and industry focused upon understanding the role of compression in the management of different clinical conditions. The ICC meet regularly and from these meetings have produced a series of eight consensus publications upon topics ranging from evidence-based compression to compression trials for arm lymphoedema. All of the current consensus documents can be accessed on the ICC website (http://www.icc-compressionclub.com/index.php). In May 2011, the ICC met in Brussels during the European Wound Management Association (EWMA) annual conference. With almost 50 members in attendance, the day-long ICC meeting challenged a series of dogmas and myths that exist when considering compression therapies. In preparation for a discussion on beliefs surrounding compression, a forum was established on the ICC website where presenters were able to display a summary of their thoughts upon each dogma to be discussed during the meeting. Members of the ICC could then provide comments on each topic thereby widening the discussion to the entire membership of the ICC rather than simply those who were attending the EWMA conference. This article presents an extended report of the issues that were discussed, with each dogma covered in a separate section. The ICC discussed 12 'dogmas' with areas 1 through 7 dedicated to materials and application techniques used to apply compression with the remaining topics (8 through 12) related to the indications for using compression.

Clinical analysis of the corona phlebectatica.

BACKGROUND: The corona phlebectatica (CP) is classically described as the presence of abnormally visible cutaneous blood vessels at the ankle with four components: "venous cups," blue and red telangiectases, and capillary "stasis spots." Previous studies showed that the presence of CP is strongly related to the clinical severity of chronic venous disorders (CVD) and the presence of incompetent leg perforators. The aim of this study was to select the most informative components of the CP in the assessment of the clinical severity of CVD patients. METHODS: A multicentric series of 262 unselected patients (524 limbs) consulted for CVD were clinically evaluated using a standardized form to record the CEAP "C" items and the presence of the four CP components. Standard categorical and ordinal statistics were used to describe the external validity of the CP components as severity indexes, taking the "C" classes as reference. RESULTS: "Stasis spots" (P < .001; r = .44) and blue telangiectases (P < .01; r = .32) were linearly associated with the ascending order of "C" classes, whereas the relationship is less clear for the red telangiectases and the "venous cups." The association pattern of the four components showed that only the blue telangiectases and the "stasis spots" were consistent with each other. Blue telangiectases were found more sensitive (0.91 vs 0.75) but less specific (0.52 vs 0.80) than "stasis spots" for advanced venous insufficiency (CEAP "C4-6"). CONCLUSION: This study shows that only blue telangiectases and "stasis spots" provide valuable information in patients with CVD and deserve to be taken into account in the evaluation of such patients. Further studies are needed to show the reproducibility of this data, which we regard as essential for clinical use.