CEAP classification

The CEAP classification is a way of classifying venous disorders, often used by doctors to describe the disease.

The acronym stands for

• C = clinical condition
• E = etiology
• A = anatomic location
• P = pathophysiology

Clinical findings are divided into 7 groups (C0 to C6): C0 means there are no visible signs of venous disease, while C1 covers small varicose veins such as spider veins and reticular veins. C2 and C3 comprise large varicose veins without or with oedema. Patients with C4 varicose veins have skin changes; C5 means that there are healed venous leg ulcers and C6 that the venous leg ulcers are active at the time of examination.

CEAP classification of the clinical extent of venous disease
Stage	Changes
C0	no visible signs of venous disease
C1	spider veins and reticular varicose veins
C2	(large) varicose veins without any complications
C3	(large) varicose veins with oedema
C4	varicose veins with skin changes
C5	healed venous leg ulcers
C6	active venous leg ulcers

In addition, a distinction is made as to whether the patient has any symptoms (s = symptomatic) or not (a = asymptomatic). C2s means that you have large varicose veins that are causing symptoms, while spider veins or reticular varicose veins classed C1a are not giving rise to any symptoms at all.

Further information provided by the CEAP classification

The classification also provides additional information about the origins (aetiology) of the disease, that is to say, whether it is primary or secondary. The vast majority of varicose veins are of primary origin, which means that they have developed because of a hereditary weakness in the connective tissue and vein walls. Secondary varicose veins are the result of another vein disease; for example, when a deep vein thrombosis causes varicose veins after the event.
Primary disease is indicated with ‘p’, with most cases thus falling into the class Ep.

The anatomical site of the disease considers whether the affected veins are superficial (s = superficial). Therefore, varicose veins (= diseased superficial veins) are classed as As.

With the final classification, it is differentiated whether there is, for example, an abnormal backwards flow of blood (r = reflux), blockage of the vein (o = occlusion) or neither of these (n = none).

The typical classification for spider veins without any symptoms is C1aEpAsPn, as there is usually no reflux to be found in primary disease affecting the small superficial veins. C2sEpAsPr accurately describes trunk varicose veins with symptoms, but with no signs of complications, as reflux can be demonstrated in these superficial primary varicose veins.