The Classification of Venous Disease
CEAP Classification

Chronic venous insufficiency is caused be venous reflux, or backward flow in the venous system. This produces venous hypertension, magnified in distal parts of the legs where gravity exerts its effects most profoundly. Recalling that venous flow in the legs normally goes from distal to proximal and superficial to deep, valve failure along these circuits leads to elevated pressures in the venous segments with progressive failure of neighboring valves as elevated pressures are propagated.
A consensus conference of leading phlebologists has developed the commonly accepted classification of venous insufficiency, from clinical class 1 to clinical class 6.

The C.E.A.P. Classification for venous disease is a method of stratifying patients according to the severity of their presentation. CEAP stands for:

  • Clinical

  • Etiologic

  • Anatomic

  • Pathophysiologic

There was an elaborate scoring system developed with these main categories and broke them down to many fine criteria with which to compare patients. The system was cumbersome to use given the variability of presentation of vein problems. The usage of CEAP has been simplified to designate CEAP categories 1–6.

The CEAP categories are as follows:

  1. Reticular and spider veins

  2. Varicose veins

  3. Varicose veins and leg swelling

  4. Varicose veins and evidence of venous stasis skin changes
             •4a – Pigmentation and /or eczema.
             •4b – Lipodermatosclerosis and /or atrophie blanche. 

  5. Varicose veins and a healed venous stasis ulceration

  6. Varicose veins and an open venous ulceration


Recommendations for new patients with venous disease:

CEAP 1 No Need to refer for medical treatment, cosmetic problem only.
CEAP 2 — Refer routinely to Vein Specialist for duplex color doppler assessment.
CEAP 3-5 — Refer early  to Vein Specialist for duplex color doppler assessment & management.
CEAP 6 — Refer urgently to Vein Specialist for duplex color doppler assessment & management of ulcer as well as                     Varicose Veins.


CEAP Class 1

Superficial Spider veins
(Reticular veins) only.

CEAP Class 2
CEAP Class 3
Simple Varicose veins only.
Ankle Edema
CEAP Class 4a
CEAP Class 4b
Skin Pigmentation and /or eczema near ankle
(Thickening of skin & subcutaneous tissue) and /or
Atrophie Blanche.
CEAP Class 5
CEAP Class 6
A Healed venous ulcer.
An Open or Active venous ulcer.
Varicose Veins
Spider Veins
Perforator Veins
Deep Vein Problem
Restless Leg Syndrome
Post Thrombotic Syndrome
CEAP Classification