Venous Clinical Severity Scale (VCSS)

Purpose

The Venous Clinical Severity Scale (VCSS) is designed to assess the severity of chronic venous disease (CVD) by evaluating various clinical parameters. This dynamic assessment tool quantitatively evaluates the severity of the disease through a comprehensive assessment of clinical symptoms and signs.  It provides a standardized method to monitor venous disease changes over time.

Significance of VCSS

In clinical practice, VCSS is used to systematically document the severity of CVD, enhancing the quality of patient care through precise assessment and targeted management strategies. The utilization of the VCSS is aligned with best practice standards in phlebology, ensuring that patient evaluations are thorough, consistent, and reflective of the latest clinical insights and methodologies. VCSS scores is quintessential to clinicians for communication of disease severity and treatment outcomes. The severity of CVD assessed via VCSS can help provide patient centered care, tailor to the patient needs.

Instructions for Use:

1. Review each parameter and assign a score based on the severity observed in the patient per limb.
2. The scoring ranges from 0 (none) to 3 (severe), depending on the presence and severity of symptoms, signs, and the use of compression therapy.
3. Sum up the scores to calculate the total VCSS score.
4. Repeat the assessment periodically to monitor changes in disease severity and treatment effectiveness.
5. Low VCSS scores may lead to conservative treatments like lifestyle changes and compression garments.
6. High scores indicate advanced venous disease and may require more intensive therapies, or surgical interventions.
7. The decision to escalate treatment depends on treatment response, symptom severity, and the impact on quality of life, not just VCSS scores.

Pros and Cons of VCSS:

Pros:

• Easy to administer.
• Validated for reliability.
• Comprehensive assessment of multiple clinical parameters.
• Standardized scoring system for consistent evaluation.
• Facilitates monitoring disease progression and treatment outcomes.
• Valuable for longitudinal follow-up.
• Improves communication among healthcare professionals.

Cons:

• Subjective interpretation of symptoms may lead to variability in scoring.
• Does not capture all aspects of venous disease, such as quality of life impact.

VCSS in Comparison with Other Similar Tools:

• Compared to the CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) classification, VCSS offers a more detailed assessment of clinical severity.
• Compared to the Venous Disability Score (VDS), which focuses on functional impairment, VCSS provides a broader evaluation including clinical signs and symptoms.
• Compared to quality-of-life instruments like the Chronic Venous Insufficiency Questionnaire (CIVIQ) or the Aberdeen Varicose Vein Questionnaire (AVVQ), VCSS is more focused on objective clinical parameters.

References:

1. Passman, M. A., McLafferty, R. B., Lentz, M. F., Nagre, S. B., Iafrati, M. D., Bohannon, W. T., Moore, F. O., Heller, J. A., & Schneider, J. R. (2011). Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools. *Journal of Vascular Surgery*, *54*(6 Suppl), 2S-9S. doi:10.1016/j.jvs.2011.06.112
2. Sadek, M., Kabnick, L. S., Rockman, C. B., Berland, T., Maldonado, T. S., Jacobowitz, G. R., Lamparello, P. J., Mussa, F. F., Cayne, N. S., & Adelman, M. A. (2021). Revised Venous Clinical Severity Score and Venous Symptoms Assessment in the Management of Venous Disease. *Annals of Vascular Surgery*, *70*, 166-174. doi:10.1016/j.avsg.2020.06.055
3. Vasquez, M. A., & Munschauer, C. E. (2008). Venous Clinical Severity Score and quality-of-life assessment tools: application to vein practice. *Phlebology*, *23*(6), 259-275. doi:10.1258/phleb.2008.008020