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Understanding CEAP Classification for Venous Insufficiency
S. Lakhanpal MD, FACSPresident & CEO
Center for Vein Restoration
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CEAP Classification
• Clinical
• Etiology
• Anatomy
• Pathophysiology
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CEAP Classifications
• Clinical Classification– C0: No visible or
palpable signs of venous disease
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CEAP Classifications
• Clinical Classification– C0: No visible or
palpable signs of venous disease
– C1: Telangiectasies or reticular veins (90%).
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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%)
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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
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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%
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CEAP Classifications
Eklof et al. J Vasc Surg 2004
• 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
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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%
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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.
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The E in CEAPEtiologic Classification
• Ec: Congenital. • Ep: Primary (Due to reflux). • Es: Secondary (Postthrombotic).
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The A in CEAPAnatomic Classification
• S: Superficial veins. • P: Perforator veins. • D: Deep veins
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US Findings and Their Clinical Correlation
• Presence of Reflux by location:• Superficial veins in 90% of the patients• GSV - 70-80%• SSV - 15-25%• Non Saphenous veins -10%• Deep system in 30%• Perforator veins 20%
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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%
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The P in CEAP Pathophysiologic Classification
• Basic CEAP: – Pr: reflux. – Po: obstruction. – Pr,o: reflux and obstruction. – Pn: no venous pathophysiology identifiable.
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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.
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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.
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VCS Scoring at Presentation
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Follow up VCS Scoring
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Thank You