venous insufficiency CEAP stagesVenous Disease is Complex But Can Be Described

So how does your vein doctor know the severity of your varicose veins? We use the Comprehensive Classification System for Chronic Venous Disorders (CEAP). And you can use it too!

Before CEAP, there wasn’t a method for healthcare professionals to classify vein disease. Instead, they would describe symptoms and rate them as mild, moderate, or severe. The approach wasn’t helpful and lacked specificity. Communication was often lacking between providers.

What the CEAP Acronym Stands For

C = clinical condition 

E = etiology

A = anatomic location 

P = pathophysiology

What is CEAP Classification?

The American Venous Forum wrote the first CEAP classification in 1994. It provides a comprehensive classification that’s accepted worldwide. Most published medical papers now use all or portions of the CEAP system. It has two parts: classification and severity scoring of lower extremity vein disease. CEAP classification ranges from C0 (no venous disease) to C6 (an open and active ulcer).

Today, all healthcare professionals use the CEAP system when describing vein disease. It’s designed to be very specific. In short, it offers everything that the previous system failed to do.

The 7 Stages of the CEAP Classification System

C0: A functioning, healthy venous system. Leg veins pulse blood back towards the heart exactly as they’re supposed to.

Severity: mild

C1: Presence of spider veins, reticular veins, or telangiectasia. By themselves, spider veins are nothing more than a cosmetic nuisance. But they do point out some level of reflux in the larger veins of the legs. They’re a direct precursor to varicose veins.

Severity: mild

C2: The formation of varicose veins. Patients begin to experience symptoms like achy legs, swelling, and cramping. This leads to increased pressure, which in turn causes surface veins to swell. Over time, they become stretched out and become varicose veins. Without treatment, it’s likely the condition with progress to the following stage.

Severity: moderate

C3: The presence of edema, a medical term for fluid retention and swelling. Compression stockings and edema pumps can manage symptoms. But treatment will help the underlying condition. A patient’s vein disease will worsen if not treated.

Severity: moderate to severe

C4: Visible skin changes. Fluid retention leads to changes in the color, texture, and appearance of the skin. The presence of eczema and brownish, purplish, or reddish blotches is common.

Severity: severe

C5: Painful ankle ulcers around the ankles that heal on their own. Chronic fluid retention will cause increased blood pressure within the leg veins. This can lead to an impaired circulation which can cause a breakdown of the overlying skin.

Severity: severe

C6: Lower extremity ulcers that don’t heal. About 1% of patients with vein disease will progress to CEAP stage 6. As the condition worsens ulcers won’t heal without specialty wound care. At this point, treatment is medically necessary. 

How Can I Classify Myself with CEAP?

Most people with varicose veins know they have bulging veins in their legs. The CEAP system will help them understand the severity of the varicose vein problem and seek the right treatment.

But when using CEAP, remember that it’s external observations of underlying health issues. A venous ultrasound scan can examine all the veins underneath. Without it, there is no full diagnosis.



Delaware State riding a bicycle to healthier veins

At Delaware Advanced Vein Center, our medical staff has years of experience helping people with their spider and varicose veins. We would love to welcome you to our family of satisfied patients. 

Contact us today to schedule a FREE virtual consultation and vein evaluation.

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