Comprehensive Classification System for Chronic Venous Disorders (CEAP)

In order to standardize the reporting and treatment of the diverse manifestations of chronic venous disorders, a comprehensive classification system (CEAP) has been developed to allow uniform diagnosis and comparison of patient populations. Created by an international ad hoc committee of the American Venous Forum in 1994, it has been endorsed throughout the world and is now accepted standard for classifying chronic venous disorders.

The fundamentals of the CEAP classification include a description of the clinical class (C) based upon objective signs, the etiology (E), the anatomical (A) distribution of reflux and obstruction in the superficial, deep and perforating veins, and the underlying pathophysiology (P), whether due to reflux or obstruction.1

Seven clinical categories are recognized as shown on the table below:

CEAP classification of chronic venous disease Clinical classification
C0 No visible or palpable signs of venous disease
C1 Telangiectasies or reticular veins
Reticular Veins

Spider Veins
C2 Varicose veins
Branch Varicose Veins

Saphenous Varicose Veins
C3 Edema
C4a Pigmentation or eczema

C4b Lipodermatosclerosis or athrophie blanche
athrophie blanche

C5 Healed venous ulcer
Healed ulcer
C6 Active venous ulcer
Active ulcer



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Yes, your risk of developing an ulcer is elevated. The vessels’ functioning is so disturbed that there is stasis. Then edema appears and your skin aspect changes – at first a color change, then it itches and eczema appears. As time passes, your skin hardens. A small wound or an inflammation due to a mosquito bite are enough to cause deterioration to your skin. An ulcer forms. These changes appear gradually and can in most cases be resolved with treatment.

No, as the risk factors like genetic predisposition and higher age cannot be treated. But you can prevent symptoms and also signs of chronic venous insufficiency if you have varicose veins. Keep moving! Use the staircase rather than the elevator. Practice a sport that stimulates your venous system like cycling, swimming, or walking. Raise your legs and move as often as possible. It is also recommended to shower your legs with cold water and to wear compression socks or stockings.