CEAP CLASSIFICATION OF VARICOSE VEINS

CEAP classification of varicose veins

The CEAP is an elaborate scoring system for varicose veins and other disorders from venous insufficiency. It has been developed to determine the severity of the condition for diagnosis and treatment point of view. CEAP stands for:

  • Clinical
  • Etiopathological
  • Anatomical
  • Pathophysiological

The CEAP scoring system is as follows:

CLINICAL CLASSIFICATIONS

C1

  • Superficial, reticular and spider veins only
  • Cosmetic problem only

C2

  • Asymptomatic varicose (visibly dilated, tortuous) veins.
  • Varicosity with symptoms. Veins are visibly dilated, tortuous. Symptoms like pain and heaviness are present, which increase on long-standing/ sitting.

C3

  • Varicose veins with swelling. Ankle swelling, venous congestion

C4

  • Superficial, reticular and spider veins only
  • Cosmetic problem only

C5

  • Varicose veins and a healed venous ulcer
  • Healed venous ulcer, skin ulceration, and tissue hypoxia

C6

  • Open venous ulcer.

ETIOLOGIC CLASSIFICATION

  • Ec: congenital (present since birth)
  • Ep: primary  
  • Es: secondary (caused by other pathologies such as after a thrombus).

ANATOMIC CLASSIFICATION

  • s: superficial veins.
  • p: perforator veins.
  • d: deep veins.

PATHOPHYSIOLOGIC CLASSIFICATION

  • For Basic CEAP:
  • Pr: reflux (backflow).
  • Po: obstruction.
  • Pr,o: reflux and obstruction.
  • Pn: no venous pathophysiology identifiable.

Advanced CEAP: It is the same as Basic CEAP as above, with the addition that any of the 18 named venous segments can be utilized as locators for venous pathology. These are as follows:

Superficial veins:

  1. Telangiectasies/reticular veins.
  2. GSV above knee.
  3. GSV below knee.
  4. LSV.
  5. Nonsaphenous veins.

Deep veins: 

  1. IVC.
  2. Common iliac vein.
  3. Internal iliac vein.
  4. External iliac vein.
  5. Pelvic: gonadal, broad ligament veins, other.
  6. Common femoral vein.
  7. Deep femoral vein.
  8. Femoral vein.
  9. Popliteal vein.
  10. Crural: anterior tibial, posterior tibial, peroneal veins (all paired).
  11. Muscular: gastrocnemial, soleal veins, other.

Perforating veins:

  1. Thigh
  2. Calf.
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