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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
C2 Varicose veins
C3 Edema
C4a Pigmentation or eczema
C4b Lipodermatosclerosis or athrophie blanche
C5 Healed venous ulcer
C6 Active venous ulcer

S = Symptomatic, including ache, pain, tightness, skin irritation, heaviness, and muscle cramps, and other complaints attributable to venous dysfunction
A = Asymptomatic

Etiological classification Anatomical classification Pathophysiology
Ec: congenital As: superficial veins Pr: reflux
Ep: primary Ap: perforating veins Po: obstruction
Es: secondary Ad: deep veins Pr,o: reflux and obstruction
En: no venous cause identified An: no venous location identified Pn: no venous pathophysiology identifiable

Designed to be a document that would evolve over time CEAP underwent its first official review and revision by an international panel under the auspices of the American Venous Forum in 2004.2 The revised document retains the basic CEAP categories, but improves the underlying details. Furthermore, to encourage wider usage among clinicians, an abbreviated version or “basic CEAP” was adopted as an alternative to the comprehensive CEAP.3

To help doctors get familiar and use the CEAP classification, Prof. Jean-François Uhl and SIGVARIS are providing an educational CD: “The CEAP game” (Available in English and French).

Please use the contact form to receive a complimentary sample of the CD.

1 Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensu Committee on Chronic Venous Disease. J Vasc Surg 1995;21:635-45
2 Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Glovicski P, Kistner RL, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Sur 2004;40:1248-52
3 Meissner et al. Primary chronic venous disorders. J Vasc Surg 2007;46:54S-67S

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