Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) Classification

Purpose:

The Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification is designed to provide a comprehensive framework for the assessment and classification of chronic venous disorders. It aims to categorize venous disease based on clinical signs, etiology, anatomical distribution, and underlying pathophysiology. CEAP classification has been in use for chronic venous disease (CVD) since 1995, it was revised in 2004 and in 2020.

Significance of CEAP:

• Offers a standardized approach for clinicians to classify and document various aspects of venous disease, and treatment planning.
• CEAP classification enables providers to communicate disease severity and characteristics effectively, both within the medical community and with patients.
• By categorizing venous disorders according to their clinical, etiological, anatomical, and pathophysiological features, CEAP helps providers to provide patient centered care, tailored to individual patient needs.

Allocation of CEAP Categories:

1. Clinical: Describes the presentation of venous disease, including symptoms and physical findings.
2. Etiological: Identifies the underlying causes or risk factors contributing to venous disease.
3. Anatomical: Specifies the anatomical location and extent of venous abnormalities.

Pathophysiological: Describes the pathophysiological mechanisms involved in venous disease progression.

Instructions for Use:

1. Evaluate the patient’s clinical symptoms and physical examination findings to determine the appropriate clinical category (C).
2. Identify any underlying etiological factors contributing to venous disease and assign the corresponding etiological category (E).
3. Determine the anatomical extent and distribution of venous abnormalities to assign the anatomical category (A).
4. Consider the underlying pathophysiological mechanisms involved in venous disease progression and assign the pathophysiological category (P).
5. Document the CEAP classification according to the assigned categories (e.g., C2E2A3P4).

Pros and Cons of CEAP:

Pros:

• Comprehensive assessment of multiple aspects of venous disease.
• Standardized classification system for consistent documentation and communication.
• Guides treatment decisions by considering various disease characteristics.

Cons:

• Complex classification system may require training for accurate implementation.
• Limited focus on patient-reported outcomes and quality of life impact.
• Some categories may be subject to interpretation, leading to variability in classification.

CEAP in Comparison with Other Similar Tools:

• Compared to the Venous Clinical Severity Scale (VCSS), CEAP offers a broader assessment encompassing etiological, anatomical, and pathophysiological aspects in addition to clinical severity.
• Compared to disease-specific tools such as the Chronic Venous Insufficiency Questionnaire (CIVIQ) or the Aberdeen Varicose Vein Questionnaire (AVVQ), CEAP provides a more comprehensive classification system applicable to a wide range of venous disorders.

Reference:

1. Eklöf, B., Rutherford, R. B., Bergan, J. J., Carpentier, P. H., Gloviczki, P., Kistner, R. L., et al. (2004). Revision of the CEAP classification for chronic venous disorders: consensus statement. Journal of Vascular Surgery, 40, 1248-1252.
2. Lurie, F., Passman, M., Meisner, M., Dalsing, M., Masuda, E., Welch, H., et al. (2020). The 2020 update of the CEAP classification system and reporting standards. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 8, 342-352.
3. Hong, K. P. (2022). The 2020 Update of the CEAP Classification: Updated Contents and Background. Annals of Phlebology, 20(1), 19-23.