The VCSS is a longitudinal measure of nine categories considered universally relevant in the diagnosis and management of CVD. It was designed to supplement CEAP and to provide an evaluative longitudinal assessment of change following treatment and disease progression [16]. It was also designed to give additional weight to more severe manifestations of CVD [18].

The VCSS is generated by the clinician during the course of patient examination and can be followed up readily. It can be used to assess the broader spectrum of CVD, as well as to compare patients with post-thrombotic syndrome and those undergoing different treatment modalities of saphenous venous ablation, stenting for venous obstruction, and pharmacomechanical thrombolysis. Although useful, the original VCSS had drawbacks. Ambiguity in the clinical descriptors was identified as a primary shortcoming of the instrument [19]. In response to these issues, the VCSS has recently been revised [20]. The specific language of proven quality-of-life instruments was used to better address the issues of patients at the lower end of the venous disease spectrum. The language that patients use in describing their symptoms has been considered as well. This revision is designed primarily to clarify the clinical descriptors and make the instrument more precise (Tables 3.1 and 3.2). It has demonstrated good correlation with the results of ultrasonography, and its simplicity makes it easy to administer and score [4]. Recently, a valuable application for the VCSS has arisen in the form of its visual descriptive power. The “visual language of VCSS” is a common framework for consistent physician scoring of venous disease (Fig. 3.4). Similarity in scoring and in descriptions of venous sequelae adds to the structure of the language of CVD.

The pain component has been adapted to include patient-reported symptoms, such as ache, heaviness, fatigue, soreness, and burning. These symptoms are often found in communicating pain of venous origin. The varicose vein category has been changed to mirror the revised CEAP classification. Corona phlebectatica has been added to this category as a mild finding (Fig. 3.5). The venous edema and skin pigmentation categories (Fig. 3.6) have been changed to reflect the extent of the findings over the surface of the leg. The inflammation category was changed to include terms that indicate acute changes, namely, erythema, cellulitis, venous eczema, and dermatitis (Fig. 3.7). The induration category added the terms chronic edema with fibrosis, hypodermitis, white atrophy, and lipodermatosclerosis to indicate severity and chronicity (Fig. 3.8). Ulcer categories were refined in regard to ulcer size and duration (Fig. 3.9). The category on the use of compression therapy eliminated leg elevation and addresses only the wearing of compression garments [20].