Ceap classification

RL Kistner, 1996

Score for the clinical assessment of venous insufficiency. S.u. Venous insufficiency, chronic/varicosis. CEAP is an acronym for:

• C = clinical signs
• E = Etiological classification (congenital, primary, secondary)
• A = Anatomical distribution (superficial, deep, perforating vein, alone or in combination)
• P = Pathophysiological dysfunction (reflux or obstruction, alone or in combination).

• C = clinical classification:
• C0 = no appearance
• C1 = spider veins and reticular varices
• C2 = Varices
• C3 = Edema
• C4a = pigmentation, purpura, eczema
• C4b = Hypodermitis, Lipodermatoscl., Atr. blanche
• C5 = healed ulcer
• C6 = open ulcer.
• E = Etiological classification:
• EC congenital (Etiology congenital)
• EP primary (Etiology primary)
• ES secondary (Etiology secundary = with known cause, e.g. postthrombotic, posttraumatic etc.).
• A = Anatomical classification:
• AS superficial (Anatomy superficial = defect in the superficial venous system):
• 1 = reticular spider veins
• 2 = V. saphena magna above the knee
• 3 = V. saphena magna below the knee
• 4 = V. saphena parva
• 5 = other veins.
• AD deep (Anatomy deep = defect in the deep venous system):
• 6 = V. cava
• 7 = V. iliaca communis
• 8 = V. iliaca interna
• 9 = V. iliaca externa
• 10 = V. pelvica
• 11 = V. femoralis communis
• 12 = V. femoralis profunda
• 13 = V. femoralis superficialis
• 14 = V. poplitea
• 15 = lower leg veins (Vv. t.a., Vv. t.p., Vv. f.)
• 16 = muscle veins (gastrocnemius; soleus, etc.).
• AP Perforantes (Anatomy of venae perforantes = defect of the perforating veins):
• 17 = thigh
• 18 = lower leg.
• P = Pathophysiological classification:
• PO = Obstruction (Pathology obliteration)
• PR = reflux (pathology reflux)
• PRO = reflux + obstruction (pathology reflux + obliteration).

Clinical example: Patient with painful varicose veins, dermatoliposclerosis and a proven reflux in the vena saphena magna below the knee and in perforating veins is classified as:

C2/4b, Ep, As3/p, Pr

in the case of Class C, only the highest classification may be given for the sake of simplicity, in this case C4b.

Corrected classification: C4b, Ep, As3/p, Pr

Since the CEAP classification is only an assessment of an actual situation, it is useful to give a date for each CEAP classification.

1. Kistner RL et al (1996) Diagnosis of chronic venous disease of the lower extremities: the "CEAP" classification. Mayo Clin Proc 71: 338-345
2. van der Velden SK et al (2015) Management Strategies for Patients with Varicose Veins (C2-C6): Results of a Worldwide Survey. Eur J Vasc Endovasc Surgery 49: 213-220