CEAP classification C6 chronic venous disease indicates which clinical finding, and what is the pathophysiological mechanism leading to this?

• A C6 = active venous ulceration; caused by sustained venous hypertension leading to leucocyte trapping, activation of proteolytic enzymes, endothelial damage, and capillary leak with pericapillary fibrin deposition ✓
• B C6 = healed venous ulceration; caused by recanalisation of deep venous thrombus
• C C6 = lipodermatosclerosis; caused by fat necrosis from venous stasis
• D C6 = skin hyperpigmentation; caused by haemosiderin deposition from extravasated red cells

Explanation

CEAP C6 = active venous leg ulcer. Sustained ambulatory venous hypertension (from deep venous insufficiency, perforator incompetence, or saphenous reflux) leads to leucocyte (neutrophil and macrophage) trapping in capillary beds, degranulation releasing proteolytic enzymes (metalloproteinases) and reactive oxygen species, endothelial injury, capillary leak, and pericapillary fibrin cuffing. This creates a hypoxic, inflammatory dermal environment and eventually ulceration. C5 = healed ulcer; C4b = lipodermatosclerosis or atrophie blanche. Haemosiderin deposition = C4a (skin staining).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.