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Classification of venous ulcers

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Classification of venous ulcers

The CEAP classification is an internationally recognised standard for describing patients with chronic venous disorders, originally developed in 1993 and updated in 1996, 2004, and 2020. It is based on clinical manifestations, aetiology, involved anatomy, and the underlying venous pathology.

  • Clinical classification - based on objective clinical signs of chronic venous disease (C0-6) and further differentiated according to whether the patient is asymptomatic (A) or symptomatic (S).
    • C0 - no visible or palpable signs of venous disease
    • C1 - telangiectasia or reticular veins
    • C2 - varicose veins
    • C3 - oedema
    • C4 - skin changes such as lipodermatosclerosis
    • C5 - healed ulceration
    • C6 - active ulceration

  • Aetiological classification
    • EC - congenital
    • EP - primary
    • ES - secondary

  • Anatomical classification - the anatomical extent of venous disease
    • AS - in the superficial vein
    • AD - deep vein
    • AP - perforating veins

  • pathophysiological classification
    • PR - reflux
    • PO - obstruction
    • PR,O - both

Chronic venous insufficiency corresponds with C3 to C6 of the CEAP classification (2)


1. Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020 May;8(3):342-52.

2. De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor's choice - European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022 Feb;63(2):184-267.

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