1. Understanding CEAP Classification for Venous Insufficiency
S. Lakhanpal MD, FACS
President & CEO
Center for Vein Restoration

2. CEAP Classification
Clinical
Etiology
Anatomy
Pathophysiology

3. CEAP Classifications Clinical Classification
C0: No visible or palpable signs of venous disease

4. CEAP Classifications Clinical Classification
C0: No visible or palpable signs of venous disease
C1: Telangiectasies or reticular veins (90%).

5. CEAP Classifications Clinical Classification
C0: No visible or palpable signs of venous disease
C1: Telangiectasies or reticular veins (90%)
C2: Varicose veins (up to 80%)

6. CEAP Classifications Clinical Classification
C0: No visible or palpable signs of venous disease
C1: Telangiectasies or reticular veins (90%)
C2: Varicose veins (up to 80%)
C3: Edema

7. CEAP Classifications Clinical Classification
C0: No visible or palpable signs of venous disease
C1: Telangiectasies or reticular veins (90%)
C2: Varicose veins (up to 80%)
C3: Edema
C4a: Pigmentation or eczema
C4b: Lipodermatosclerosis or atrophie blanche
Skin changes in up to 25%

8. CEAP Classifications Clinical Classification
C0: No visible or palpable signs of venous disease
C1: Telangiectasies or reticular veins (90%)
C2: Varicose veins (up to 80%)
C3: Edema
C4a: Pigmentation or eczema
C4b: Lipodermatosclerosis or atrophie blanche
C5: Healed venous ulcer
Eklof et al. J Vasc Surg 2004

9. CEAP Classifications Clinical Classification
C0: No visible or palpable signs of venous disease
C1: Telangiectasies or reticular veins (90%)
C2: Varicose veins (up to 80%)
C3: Edema
C4a: Pigmentation or eczema
C4b: Lipodermatosclerosis or atrophie blanche
C5: Healed venous ulcer
C6: Active venous ulcer
Ulcer in up to 10%

10. CEAP Classification – Symptomatic or Asymptomatic
S: Symptomatic (ache, pain, tightness, skin irritation, heaviness, and muscle cramps)
A: Asymptomatic
Duplex US and its correlation with symptoms:
Up to 4/5th of the patients presenting with CVD are symptomatic with achiness heaviness, tiredness, restless limb, burning and ulceration.

11. The E in CEAP Etiologic Classification
Ec: Congenital.
Ep: Primary (Due to reflux).
Es: Secondary (Postthrombotic).

12. The A in CEAP Anatomic Classification
S: Superficial veins.
P: Perforator veins.
D: Deep veins

13. US Findings and Their Clinical Correlation
Presence of Reflux by location:
Superficial veins in 90% of the patients
GSV %
SSV %
Non Saphenous veins -10%
Deep system in 30%
Perforator veins 20%

14. US Findings and Their Clinical Correlation
Ulcers and reflux:
Superficial system alone: up to 50% but Superficial reflux is present in up to 95%
Isolated deep vein reflux<10%. Popliteal vein has strongest correlation.
Veins in the ulcer bed and 2 cms around it, reflux in up to 90%

15. The P in CEAP Pathophysiologic Classification
Basic CEAP:
Pr: reflux.
Po: obstruction.
Pr,o: reflux and obstruction.
Pn: no venous pathophysiology identifiable.

16. US Findings and Their Clinical Correlation
Duplex US and severity of disease:
C1-2: Reflux limited to the superficial system
C3-6: Prevalence of deep vein reflux and perforator reflux increases.
C4-6: Higher incidence of combined obstruction and reflux.

17. The Need for VCS Scoring
The American Venous Forum(AVF) realized the lack of dynamism with the CEAP scoring, hence came up with the revised VCS Score.
In this system clinical descriptors with the ability to change over months were graded from 0-3. Hence a more practical way to track the short term changes in the patient’s clinical condition.

18. VCS Scoring at Presentation

19. Follow up VCS Scoring

20. Thank You