Clinical-Etiology-Anatomy-Pathophysiology (CEAP) Classification of Venous Disease

Clinical-Etiology-Anatomy-Pathophysiology (CEAP) Classification of Venous Disease

It is considered best practice to use the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system that represents an international consensus method to categorize chronic venous disease (Table 4). This classification system although not correlated with outcomes, does provide the clinician with a structured framework with the C or Clinical being the most useful when in clinical practice. The most recent update was published in 2020 (Musil, 2021). The major change is C4, corona phlebectatica that is considered an early marker for the development of more advanced disease. There is now a designation for a recurrent ulcer listed below as C6r.

Table 4. The CEAP Classification for Venous Disease

CEAP tool Meaning
C Clinical findings
E Etiological factors
A Anatomical site
P Pathophysiological cause


Clinical C0 No visible or palpable signs of venous disease
C1 Telangiectasias or reticular veins
C2 Varicose veins
C3 Presence of oedema
C4a Eczema or pigmentation
C4b Lipodermatosclerosis or atrophie (atrophy) blanche
C4c Corona phlebectatica
C5 Evidence of a healed venous leg ulcer
C6 Active venous leg ulcer symptoms
C6r Recurrent ulcer
Etiological Ec Congenital
Ep Primary
Es Secondary (post-thrombosis)
En No venous etiology
Anatomical As Superficial veins
Ap Perforating veins
Ad Deep veins
An No venous location identified
Pr Reflux
Ap Obstruction
Ad Reflux and obstruction
An No venous pathophysiology identified




Share This Book