Interventional Radiology · Peripheral venous disease · CEAP 2020
CEAP Classification of Chronic Venous Disorders
The CEAP system describes chronic venous disorders according to clinical manifestations, aetiology, anatomical distribution and pathophysiology. This entry uses the 2020 revision.
Purpose
To provide a standardised description of chronic venous disorders of each lower limb using Clinical, Etiological, Anatomical and Pathophysiological components.
| Component | Code | Definition |
|---|---|---|
| Clinical | C0 | No visible or palpable signs of venous disease |
| Clinical | C1 | Telangiectasias or reticular veins |
| Clinical | C2 | Varicose veins |
| Clinical | C2r | Recurrent varicose veins |
| Clinical | C3 | Oedema |
| Clinical | C4 | Skin or subcutaneous tissue changes secondary to chronic venous disease |
| Clinical | C4a | Pigmentation or eczema |
| Clinical | C4b | Lipodermatosclerosis or atrophie blanche |
| Clinical | C4c | Corona phlebectatica |
| Clinical | C5 | Healed venous ulcer |
| Clinical | C6 | Active venous ulcer |
| Clinical | C6r | Recurrent active venous ulcer |
| Symptom modifier | S | Symptoms attributable to venous disease are present |
| Symptom modifier | A | Symptoms attributable to venous disease are absent |
| Aetiology | Ec | Congenital |
| Aetiology | Ep | Primary |
| Aetiology | Es | Secondary |
| Aetiology | Esi | Secondary cause arising within the venous system |
| Aetiology | Ese | Secondary cause arising outside the venous system |
| Aetiology | En | No venous cause identified |
| Anatomy | As | Superficial veins |
| Anatomy | Ad | Deep veins |
| Anatomy | Ap | Perforating veins |
| Anatomy | An | No venous anatomical location identified |
| Pathophysiology | Pr | Reflux |
| Pathophysiology | Po | Obstruction |
| Pathophysiology | Pr,o | Reflux and obstruction |
| Pathophysiology | Pn | No venous pathophysiology identified |
How to use it
- Basic CEAP records the single highest clinical class present in each limb; advanced CEAP may document every clinical class present.
- Append S or A to the clinical class to indicate whether symptoms attributable to venous disease are present or absent.
- The 2020 revision introduced C4c for corona phlebectatica and the recurrent-disease modifier r for C2 and C6.
- A complete CEAP description includes the clinical class together with aetiological, anatomical and pathophysiological findings; anatomical categories may be combined and further localised using named venous-segment abbreviations.
- CEAP describes the limb at a particular time and is not a treatment algorithm or longitudinal severity score.
Common mistake
Do not equate the C class alone with the complete CEAP classification or use CEAP as a numerical severity score. Classify each limb separately and do not omit the symptom modifier or the E, A and P components when complete reporting is required.
Exam pearl
Remember the clinical progression: C0 none, C1 telangiectasias, C2 varicose veins, C3 oedema, C4 skin change, C5 healed ulcer and C6 active ulcer; the 2020 additions are C4c, C2r and C6r.
Viva questions
- What does CEAP stand for?
- CEAP stands for Clinical, Etiological, Anatomical and Pathophysiological classification of chronic venous disorders.
- Enumerate the clinical classes from C0 to C6.
- C0 is no visible or palpable disease, C1 telangiectasias or reticular veins, C2 varicose veins, C3 oedema, C4 venous skin or subcutaneous changes, C5 healed venous ulcer and C6 active venous ulcer.
- How is the C4 clinical class subdivided?
- C4a denotes pigmentation or eczema, C4b denotes lipodermatosclerosis or atrophie blanche, and C4c denotes corona phlebectatica.
- Which recurrent-disease modifiers were introduced in the 2020 CEAP revision?
- C2r denotes recurrent varicose veins and C6r denotes a recurrent active venous ulcer.
- What do the S and A modifiers mean in the clinical component?
- S indicates symptoms attributable to venous disease, whereas A indicates the absence of attributable venous symptoms.
- What are the anatomical categories in CEAP?
- As denotes superficial veins, Ad deep veins, Ap perforating veins and An no identified venous anatomical location.
- How is venous pathophysiology coded in CEAP?
- Pr indicates reflux, Po obstruction, Pr,o combined reflux and obstruction, and Pn no identifiable venous pathophysiology.
- Is CEAP a severity score or treatment algorithm?
- No. CEAP is a descriptive classification of each limb at a particular time; it does not directly measure longitudinal severity or prescribe treatment.