Which groups of patients will CIVIQ assess?

Chronic venous disease encompasses the full spectrum of signs and symptoms associated with classes C0s to C6 of the clinical, etiologic, anatomical and pathophysiological (CEAP) classification.1 Leg symptoms associated with CVD include tingling, aching, burning, pain, muscle cramps, sensation of swelling, sensations of throbbing or heaviness, itching skin, restless legs, leg tiredness and/or fatigue.2 Although not pathognomonic, these may be suggestive of CVD, particularly if they are exacerbated by heat or dependency during the course of the day and relieved with leg rest and/or elevation.2 Limbs categorized in any clinical class may be symptomatic (S) or asymptomatic (A).

CIVIQ-20 targets C0s to C4 patients. (Table 1) The scale deliberately does not target patients with venous ulcers, as items that are relevant to patients with varicose veins or edema do not apply to patients with venous ulcers. While most C0s to C4 patients report limited social or physical activities and psychological frustration, like not being able to do sport or to travel by bus or plane, and feel embarrassed to show their legs, patients with ulcers, who are mostly elderly, are less likely to complain about such things.
“Quality-of-life scales are not like thermometers or spirometers, where the reading is independent of the type of patient.”3 This remark from Hyland is relevant when assessing the quality of life of patients suffering of CVD with a specific instrument such as CIVIQ-20. CIVIQ-20 showed good validity and good ability to detect changes after treatment. This makes it a reliable scale for both discriminative and evaluative results. This has been confirmed by the extensive use of CIVIQ-20 in recent years, to compare the effect of surgery techniques for varicose veins, or after venous stenting, or to assess the efficacy of compression therapy, vein electrostimulation, drug therapy, or physical therapy. Most of these trials were conducted in C2 to C5 patients. Some included C0s and C1 patients, but none included C6 patients. (For references of studies that have used the CIVIQ scale, please refer to the bibliography, which contains)

CIVIQ is recommended for use in C0s to C4 patients

Table 1. Domains assessed by CIVIQ-20 according to the revised CEAP clinical classification of chronic venous disease of the lower limb.1
Clinical class Description
C0 No visible or palpable signs of venous disease
C1 Telangiectases or reticular veins

  • Telangiectases defined by dilated intradermal venules
  • Reticular veins defined by dilated, nonpalpable, subdermal veins ≤3 mm in diameter
C2 Varicose veins distinguished from reticular veins by a diameter of 3 mm or more
C3 Edema
C4 Changes in skin and subcutaneous tissue secondary to CVD divided into 2 subclasses to define the differing severity of venous disease better

  • C4a, Pigmentation or eczema
  • C4b, Lipodermatosclerosis or atrophie blanche


  1. Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40(6):1248-1252.
  2. Eklof B, Perrin M, Delis K, Rutherford R. Updated terminology of chronic venous disorders: the VEIN- TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009;49(2):498-501.
  3. Hyland ME. Recommendations from quality of life scales are not simple. BMJ. 2002;325(7364):599.