During the Fifth Annual Meeting of the American Venous Forum 1993, John Porter suggested a classification for venous disease, just like the TNM (tumor/node/metastasis) classification for cancer. In 1994, the American Venous Forum created a classification system to aid universally uniform diagnosis and comparison of chronic venous disorders. In 1995, the classification was incorporated into the “Reporting Standards in Venous Disease.” In 2004 the classification underwent revision, which retained the basic CEAP categories but improved the underlying details. The name CEAP classification stands for Clinical (C), Etiological (E), Anatomical (A), and Pathophysiological (P).[1][2][3]
Seven clinical categories are recognized as below:[1][2][4]
The etiological classification divides into:
Anatomical classification divides into four categories:
Last is the pathophysiology classification, divided into four categories:
In advanced CEAP classification, there is an addition of 18 named venous segments to locate the venous pathology.[1]
Before the CEAP classification, the diagnosis of the chronic venous disorder lacked precision in diagnosis. This problem had led to reporting errors in studies of the management of venous problems. CEAP classification was then adopted worldwide, providing a universally understandable description, and it became an instrument to standardize the diagnosis and allow better communication of chronic venous disorder diagnosis between healthcare professionals. Accurate classification and proper diagnosis of the disease will help to create a base for better management for this condition.[1][5]
Example of the CEAP classification application:
A patient comes in with swelling and tightness of the leg. On physical examination, the examiner observes varicose veins, lipodermatosclerosis, and healed ulceration. Duplex scanning report showed great saphenous vein reflux and popliteal and anterior tibial reflux. Signs of postthrombotic obstruction are negative.
The use of CEAP classification results in an organized categorization of the critical elements of the venous abnormalities and clarifies the interrelationships between the causes, clinical manifestations, and anatomic distribution. Therefore, this classification method will help facilitate interinstitutional studies.[6]
To determine the CEAP classification requires an interprofessional team of healthcare professionals that includes nurses and clinicians in different specialties such as an internist, cardiologist, and radiologist. Besides doing a thorough physical examination to determine the clinical categories of the patient, it is essential to have a clear medical history of the patient to come up with the etiology of the disease. To identify specific sites of venous obstruction, duplex ultrasound, computed tomographic (CT), magnetic resonance (MR), or catheter-based contrast venography are used.[7] [Level 1]
[1] | Eklöf B,Rutherford RB,Bergan JJ,Carpentier PH,Gloviczki P,Kistner RL,Meissner MH,Moneta GL,Myers K,Padberg FT,Perrin M,Ruckley CV,Smith PC,Wakefield TW, Revision of the CEAP classification for chronic venous disorders: consensus statement. Journal of vascular surgery. 2004 Dec; [PubMed PMID: 15622385] |
[2] | Lurie F,Passman M,Meisner M,Dalsing M,Masuda E,Welch H,Bush RL,Blebea J,Carpentier PH,De Maeseneer M,Gasparis A,Labropoulos N,Marston WA,Rafetto J,Santiago F,Shortell C,Uhl JF,Urbanek T,van Rij A,Eklof B,Gloviczki P,Kistner R,Lawrence P,Moneta G,Padberg F,Perrin M,Wakefield T, CEAP classification system and reporting standard, revision 2020. Journal of vascular surgery. Venous and lymphatic disorders. 2020 Feb 26; [PubMed PMID: 32113854] |
[3] | Waheed SM,Kudaravalli P,Hotwagner DT, Deep Vein Thrombosis (DVT) 2020 Jan; [PubMed PMID: 29939530] |
[4] | Meissner MH,Gloviczki P,Bergan J,Kistner RL,Morrison N,Pannier F,Pappas PJ,Rabe E,Raju S,Villavicencio JL, Primary chronic venous disorders. Journal of vascular surgery. 2007 Dec; [PubMed PMID: 18068562] |
[5] | Eklöf B, CEAP classification and implications for investigations. Acta chirurgica Belgica. 2006 Nov-Dec [PubMed PMID: 17290688] |
[6] | Kistner RL,Eklof B,Masuda EM, Diagnosis of chronic venous disease of the lower extremities: the [PubMed PMID: 8637255] |
[7] | Souroullas P,Barnes R,Smith G,Nandhra S,Carradice D,Chetter I, The classic saphenofemoral junction and its anatomical variations. Phlebology. 2017 Apr; [PubMed PMID: 26924361] |