B-flow ultrasonograph over a valve of the great saphenous vein, showing a<unk>  reflux (flow toward right in the image). History and examination by a clinician for characteristic signs and symptoms are sufficient in many cases in ruling out systemic causes of<unk>  hypertension such as hypervolemia and heart failure. A duplex ultrasound (doppler ultrasonography and b-mode) can detect<unk>  obstruction or valvular incompetence as the cause, and is used for planning<unk>  ablation procedures, but it is not necessary in suspected<unk><unk>  where surgical intervention is not indicated.<unk>  within a<unk>  segment is defined as reflux of more than 0.5 seconds with distal compression. Invasive venography can be used in patients who may require surgery or have suspicion of<unk>  stenosis. Other modalities that may be employed are: ankle-brachial index to exclude arterial pathology, air or photoplethysmography, intravascular ultrasound, and ambulatory<unk>  pressures, which provides a global assessment of<unk>  competence.<unk>  plethysmography can assess for reflux and muscle pump dysfunction but the test is laborious and rarely done. The<unk>  filling time after the patient is asked to stand up from a seated position also is used to assess for<unk> . Rapid filling of the legs less than 20 seconds is abnormal. Classification Acute ulcer (45 x 30 mm). CEAP classification is based on Clinical, Etiological (causal), Anatomical, and Pathophysiological factors. According to Widmer Classification for assessment of<unk>  <unk> , diagnosis of<unk>  is clearly differentiated from varicose veins. It has been developed to guide decision-making in<unk>  evaluation and treatment. The CEAP classification for<unk>  is as follows: * Clinical * C0: no obvious feature of<unk>  disease * C1: the presence of reticular or spider veins * C2: Obvious varicose veins * C3: Presence of edema but no skin changes * C4: skin discoloration, pigmentation * C5: Ulcer that has healed * C6: Acute ulcer * Etiology * Primary * Secondary (trauma, birth control pill) * Congenital (Klipper trenaunay) * No cause is known * Anatomic * Superficial * Deep * Perforator * No obvious anatomic location * Pathophysiology * Obstruction, thrombosis * Reflux * Obstruction and reflux * No<unk>  pathology
Chronic venous insufficiency
Compartment syndrome
Arterial insufficiency ulcer
Lymphedema
Diabetic foot
Lipedema
Raynaud syndrome
Deep vein thrombosis