Varicose Vein Treatment: CEAP Classification Can Help

In the field of varicose vein treatment, the variety of cases doctors see and treat range from very mild cosmetic issues to severe open ulcer wounds in the leg. Therefore, a comprehensive and standardized system of classification was developed, called CEAP, to help doctors and other vein specialists communicate more effectively with each other. This is especially important when a general practitioner makes a referral for potential varicose vein treatment to a vein doctor. If the general practitioner uses the CEAP classification, he or she can immediately convey to the specialist how urgent the case may be.

CEAP is an acronym and each letter stands for a different aspect of varicosity a doctor can report.

C = Clinical

A clinical assessment is a description of what a patient’s problem veins look like, as well as the surrounding skin. Plus, the patient will be asked for what symptoms they are experiencing. We’ll cover this in more detail below.

E = Etiology

Etiology is the study of the cause of disease. For example, vein doctors always want to know about your family history. Do other members of your family have varicose veins or not? Varicose veins have a strong genetic component. You vein doctor will also want to know if you are active or sedentary and what type of work you do. Do you sit at a desk all day, stand in one place, or move around a lot for your job?

A = Anatomy

This is very basic. Which veins are giving you problems, symptom wise, or which veins visually show a problem. In other words, which veins are bulging out, twisting, throbbing, stinging, hurting, etc.

P = Pathophysiology

Pathophysiology is the study of what is causing a problem in the patient’s physiology. In this case, a vein doctor would be interested in knowing whether or not the blood flow is blocked in any region of your veins. They’d also want to know whether or not blood is pooling in any particular place (stasis). They’d want to look at the structure of vein valves too to determine if they are functioning normal or not. This is why a good vein doctor will never perform varicose vein treatment without first conducting a duplex ultrasound (doppler ultrasound).

The clinical portion of the CEAP classification system ranges from C0 through C6, progressing from least severe to most severe. Let’s take a look at each level.


This means there is no visible sign of any type of venous disease and the patient is not having any symptoms associated with spider veins or varicose veins.


The patient has noticeable spider veins (telangectasia) and or reticular veins. Spider veins are less than one millimeter in diameter. Reticular veins are not as small as spider veins but they are smaller than varicose veins. They are one millimeter to four millimeters in diameter whereas varicose veins are greater than four millimeters in diameter. They are most often found on the back of the knee. Reticular veins are also often “feeder veins” for spider veins so treating them can sometimes make associated spider veins improve as well. In some cases, if spider veins are treated without treating associated reticular veins, they’ll come right back! If varicose vein treatment is performed at this stage, it is usually considered cosmetic and many insurance companies will not cover it unless the treatment is done in conjunction with areas that are in more advanced stages.


Varicose veins are visually present. Some people split C2 into two categories depending on whether or not the patient is experiencing any symptoms associated with their varicose veins. Symptoms might include pain, a feeling of heaviness, itchiness, stinging, cramping, skin changes, and restless leg at night while trying to sleep. C2A stands for Asymptomatic stage 2 and C2S stands for stage 2 with Symptoms. This is the stage where vein doctors may consider different forms of varicose vein treatment for medical reasons and many insurance companies will cover it.


In addition to the presence of varicose veins with symptoms, there is edema, i.e. swelling of the leg, especially around the ankle. General doctors will tell their patients to see a specialist ASAP at this stage so that the vein doctor can intervene with varicose vein treatment before it gets worse. There is also a chance that a blood clot has formed and this will need to be treated ASAP.

The vein doctor will look for edema usually from the back of the ankle while the patient stands as the most reliable way to judge this. At this stage, varicose vein treatment is almost always recommended to relieve the symptom of swelling, and possibly other symptoms as well. They will conduct a duplex ultrasound test to see if there is any venous reflux (backward flow of blood) or blocked flow of blood in deep varicose veins that may not be seen from the surface of the skin.


Skin damage will be evident at this stage, usually in the form of discoloration in the region of the leg from below the knee to above the ankle. The skin changes are due to venous stasis (pooling of the blood). However, there will be no signs of leg ulcers or past leg ulcers that have healed at this stage.


Beyond varicose veins, symptoms, swelling, and skin discoloration, there are signs of past leg ulcers that have healed.


There is an open active leg ulcer. A referral from a general doctor to a vein specialist would be considered URGENT at this level to deal with the wound and prevent the spread of infection. They would likely be willing to see you right away.

Schedule an Appointment At Metro Vein Centers

You do not have to have a referral to get a free examination at Metro Vein Centers, especially if you see any of the signs of varicose veins listed above. Before your vein doctor decides what type(s) of varicose vein treatment would be best for you, he or she will consider all four of your CEAP classification attributes. He or she will also perform a duplex ultrasound to ascertain some of the most important information in the CEAP classification, such as whether or not there is venous reflux.