CEAP Classification of Venous Disorders

Issues of Concern

Seven clinical categories are recognized as follows:

• C0 No visible or palpable signs of venous disease
• C1 Telangiectasies or reticular veins
• C2 Varicose veins; distinguished from reticular veins by a diameter of 3mm or more
• C3 Edema
• C4 Changes in skin and subcutaneous tissue secondary to CVD
  • C4a Pigmentation or eczema
  • C4b Lipodermatosclerosis or atrophic blanche
• C5 Healed venous ulcer.
• C6 Active venous ulcer.

• S: Symptomatic
• A: Asymptomatic [1][2][4]

The etiological classification is divided into:

• Ec: Congenital
• Ep: Primary
• Es: Secondary
• En: No venous cause identified

Anatomical classification is divided into 4 categories:

• As: superficial veins
• Ap: perforating veins
• Ad: deep veins
• An: no venous location identified

Last is the pathophysiology classification, divided into 4 categories:

• Pr: Reflux
• Po: obstruction
• Pr,o: reflux and obstruction
• Pn: no venous pathophysiology identifiable

In advanced CEAP classification, there is an addition of 18 named venous segments to facilitate the localization of venous pathology:

• Superficial veins
  • Telangiectasies or reticular veins
  • Great saphenous vein above the knee
  • Great saphenous vein below the knee
  • Small saphenous vein
  • Nonsaphenous veins
• Deep veins
  • Inferior vena cava
  • Common iliac vein
  • Internal iliac vein
  • External iliac vein
  • Pelvic: gonadal, broad ligament veins, other
  • Common femoral vein
  • Deep femoral vein
  • Femoral vein
  • Popliteal vein
  • Crural: anterior tibial, posterior tibial, peroneal veins (all paired)
  • Muscular: gastrocnemius, soleal veins, other
• Perforating veins:
  • Thigh
  • Calf [1]

Clinical Significance

Before the CEAP classification, the diagnosis of chronic venous disorder lacked precision. This issue has led to reporting errors in studies on the management of venous disorders. The CEAP classification was then adopted worldwide, providing a universally understandable description, and it became an instrument to standardize diagnosis and facilitate better communication of chronic venous disorder diagnoses between healthcare professionals. Accurate classification and proper diagnosis of the disease provide a foundation for effective management of this condition.[1][5]

Example of the CEAP classification application: A patient presents with swelling and tightness in the leg. On physical examination, the examiner observes varicose veins, lipodermatosclerosis, and healed ulceration. The duplex scanning report reveals significant saphenous vein reflux and reflux in the popliteal and anterior tibial veins. Signs of postthrombotic obstruction are negative.

• CEAP Classification: C2, 3, 4b, 5, S, Ep, As, d, Pr

Nursing, Allied Health, and Interprofessional Team Interventions

The use of CEAP classification results in an organized categorization of the critical elements of the venous abnormalities and clarifies the interrelationships between the causes, clinical manifestations, and anatomic distribution. Therefore, this classification method helps facilitate interinstitutional studies.[6] Determining the CEAP classification requires an interprofessional team of healthcare professionals, including clinicians, mid-level practitioners, nurses, and specialists in different specialties such as internists, cardiologists, and radiologists. Besides conducting a thorough physical examination to determine the patient's clinical categories, it is essential to have a clear medical history to identify the etiology of the disease. To identify specific sites of venous obstruction, duplex ultrasound, computed tomography, magnetic resonance imaging, or catheter-based contrast venography is used.[7]