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CEAP classification for chronic venous disorders

Clinical classification
C₀	No visible or palpable signs of venous disease
C₁	Telangiectasias, reticular veins
C₂	Varicose veins
C_2r	Recurrent varicose veins
C₃	Edema
C₄	Changes in skin and subcutaneous tissue secondary to chronic venous disease
C_4a	Pigmentation or eczema
C_4b	Lipodermatosclerosis or atrophie blanche
C_4c	Corona phlebectatica
C₅	Healed
C₆	Active venous ulcer
C_6r	Recurrent active venous ulcer
S	With symptoms attributable to venous disease
A	Absence of symptoms attributable to venous disease
Etiology classification
E_p	Primary
E_s	Secondary
E_si	Secondary (intravenous)
E_se	Secondary (extravenous)
E_c	Congenital
E_n	No cause identified
Anatomy classification*
A_s	Superficial veins (Tel, Ret, GSV_a, GSV_b, SSV, AASV, NSV)
A_d	Deep veins (IVC, CIV, IIV, EIV, PELV, CFV, DFV, FV, POPV, TIBV, PRV, ATV, PTV, MUSV, GAV, SOV)
A_p	Perforator veins (TPV, CPV)
A_n	No venous anatomic location identified
Pathophysiology classification*
P_r	Reflux
P_o	Obstruction
P_r,o	Reflux and obstruction
P_n	No venous pathophysiology identifiable

Limbs in higher categories have more severe signs of chronic venous disease and may have some or all of the findings defining a less severe clinical category. Each limb is further characterized as asymptomatic (C_0-6, A) or symptomatic (C_0-6, S).
Symptoms that may be associated with telangiectatic, reticular, or varicose veins include lower extremity aching, pain, and skin irritation. Therapy may alter the clinical category of chronic venous disease. Limbs should therefore be reclassified after any form of medical or surgical treatment.

CEAP: Clinical-Etiology-Anatomy-Pathophysiology; Tel: telangiectasia; Ret: reticular veins; GSV_a: great saphenous vein above the knee; GSV_b: great saphenous vein below the knee; SSV: small saphenous vein; AASV: anterior accessory saphenous vein; NSV: nonsaphenous vein; IVC: inferior vena cava; CIV: common iliac vein; IIV: internal iliac vein; EIV: external iliac vein; PELV: pelvic veins; CFV: common femoral vein; DFV: deep femoral vein; FV: femoral vein; POPV: popliteal vein; TIBV: tibial vein; PRV: peroneal vein; ATV: anterior tibial vein; PTV: posterior tibial vein; MUSV: muscular vein; GAV: gastrocnemius vein; SOV: soleal vein; TPV: thigh perforator vein; CPV: calf perforator vein.
* Specific anatomic location(s) to be reported under each pathophysiologic (P) class to identify anatomic location(s) corresponding to P class.

From: Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord 2020; 8:342. Reproduced with permission from the Society for Vascular Surgery. Copyright © 2020 Society for Vascular Surgery. All rights reserved.

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