This venous clinical severity score (VCSS) calculator is used to monitor changes in venous disease severity based on lower extremity symptoms. Below the form there is in depth information on the origin of the model, instructions on how to perform the assessment and details on the revised version.


Instruction: Please apply the score for each leg separately.




Varicose veins


Venous edema








Number of active ulcers


Active ulceration, duration


Active ulcer size


Compressive therapy

How does this venous clinical severity score (VCSS) calculator work?

This health tool belongs to the Venous Severity Scoring (VSS) system, along the venous disability score (VDS) and the venous segmental disease score (VSDS).

The VCSS is derived by the American Venous Forum from the CEAP classification (clinical grade, etiology, anatomy, pathophysiology) and provides means by which clinical outcomes in venous disease can be monitored in time.

Compared to the CEAP, VCSS is said to be more responsive to changes in disease severity, thus making it great for progressive rankings. It proved good inter and intra observer reproducibility and is often cited in quality of life assessments.

Scores that can be obtained range between 0 and 30. The results for each leg can be used to monitor progress, especially before and after venous intervention or to monitor compliance to compressive therapy.

The items scored in the VCSS are:

■ Pain – for example, aching, heaviness, fatigue or soreness, all presumed with venous origin. The clinician is advised to describe the types of pain to the patient.

■ Varicose veins – must be more than 4 mm to qualify for differentiation. The clinician examines each limb in standing position and assesses superficial veins.

■ Venous edema – presumes venous origin. The clinician examines the pattern of leg edema.

■ Skin pigmentation – does not include focal pigmentation over varicose veins or pigmentation caused by other diseases.

■ Inflammation – that is more than recent pigmentation (for example signs of erythema, dermatitis, venous eczema).

■ Induration – presumes venous origin of secondary skin and subcutaneous changes such as fibrosis, hypodermitis, white atrophy and lipodermatosclerosis.

■ Number of active ulcers – based on the examination of each leg.

■ Active ulcer duration – accounts for the longest active.

■ Active ulcer size – accounts for the largest active.

■ Compressive therapy – the clinician needs to choose the level of compliance with the therapy.

Revised venous clinical severity score

The following table introduces the revised VCSS:

Item Absent (0 points) Mild (1 point) Moderate (2 points) Severe (3 points)
Pain None Occasional Daily Daily limiting
Varicose veins None Few Calf or thigh Calf and thigh
Venous edema None Foot and ankle Above ankle, below knee To knee of above
Skin pigmentation None Perimalleolar Diffuse, lower 1/3 calf Wider, above lower 1/3 calf
Inflammation None Perimalleolar Diffuse, lower 1/3 calf Wider, above lower 1/3 calf
Induration None Perimalleolar Diffuse, lower 1/3 calf Wider, above lower 1/3 calf
No. active ulcers None 1 2 ≥3
Active ulcer size None <2 cm 2 – 6 cm >6 cm
Ulcer duration None <3 months 3 – 12 months >1 year
Compression therapy None Intermittent Most days Fully comply

The revised version focused on clarifying some of the ambiguities and on simplifying the application of the score.

Some recommend that the revised VCSS to be used for clinical outcome assessment in the case of patients who underwent therapy for varicose veins.


1) Rutherford RB, Padberg Jr FT, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. (2000) Venous severity scoring: An adjunct to venous outcome assessment* Journal of Vascular Surgery; Volume 31(6): 1307–1312.

2) Rutherford, RB. (1996) Presidential address: vascular surgery—comparing outcomes. J Vasc Surg; 23: 543–553.

3) Passman MA, McLafferty RB, Lentz MF, Nagre SB, Iafrati MD, Bohannon WT, Moore CM, Heller JA, Schneider JR, Lohr JM, Caprini JA. (2011) Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program. J Vasc Surg;54(6 Suppl):2S-9S.

4) Vasquez MA, Rabe E, McLafferty RB, Shortell CK, Marston WA, Gillespie D, Meissner MH, Rutherford RB. (2010) Revision of the venous clinical severity score: Venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes Working Group Presented at the Twenty-second Annual Meeting of the American Venous Forum.

5) Rossi FH, Volpato MG, Metzger PB, Baumann Beteli C et al. (2015) Relationships between severity of signs and symptoms and quality of life in patients with chronic venous disease. J. vasc. bras. vol.14 no.1 Porto Alegre.

04 Nov, 2016