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CEAP 2020

classification of chronic venous disorders

Per-limb Clinical-Etiologic-Anatomic-Pathophysiologic description of lower-extremity chronic venous disorders; the C axis is descriptive and is not a linear severity score.

vigenteAmerican Venous Forum2020Clinical, US
Fonte primária11 categorias
C0C0, no visible or palpable signsC1C1, telangiectasias or reticular veinsC2C2, varicose veinsC2rC2r, recurrent varicose veinsC3C3, edemaC4aC4a, pigmentation or eczemaC4bC4b, lipodermatosclerosis or atrophie blancheC4cC4c, corona phlebectaticaC5C5, healed venous ulcerC6C6, active venous ulcerC6rC6r, recurrent active venous ulcer

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Categorias

Reescritas a partir da fonte e citadas
C0
1 de 11

C0, no visible or palpable signs

No visible or palpable signs of venous disease in the classified lower extremity. C0 may still be suffixed s when symptoms attributable to venous disease are present or a when they are absent.

CondutaDo not equate C0 with normal venous hemodynamics. If the limb is symptomatic, complete the separate E, A and P assessment as clinically indicated; the C0 label itself supplies no treatment recommendation.
RiscoC0 is a descriptive examination finding, not a zero-risk category. It does not quantify future progression or exclude reflux, obstruction, or another venous cause of symptoms.
verificadoThe 2020 update of the CEAP classification system and reporting standardsLurie et al. 2020 CEAP update, DOI 10.1016/j.jvsv.2019.12.075, Table III (C0) and Clinical working-group discussion item 1 (C0s can have reflux/obstruction or no identified venous pathology).
C1
2 de 11

C1, telangiectasias or reticular veins

Telangiectasias or reticular veins in the classified limb. The 2020 task force retained them together as C1 rather than creating separate C1 subclasses.

CondutaUse C1 as a clinical descriptor and add symptom status plus E/A/P findings when known. Do not infer a target vein, reflux, obstruction, or need for intervention from C1 alone.
RiscoC1 carries no calibrated probability of progression, ulceration, or treatment benefit. The C ordering is not a linear severity or natural-history scale.
verificadoThe 2020 update of the CEAP classification system and reporting standardsLurie et al. 2020, Table III (C1) and Other Proposed Revisions (separate telangiectasia and reticular-vein subclasses were considered but not adopted).
C2
3 de 11

C2, varicose veins

Varicose veins in the classified limb without using the recurrence modifier. Vein diameter is not part of the 2020 CEAP C category, and origin or responsible venous segment must be described through E/A/P rather than inferred from C2.

CondutaRecord s or a and complete etiology, anatomy and pathophysiology before management decisions. C2 does not identify which vein should be treated and is not itself an indication for a procedure.
RiscoC2 describes current varicose veins but supplies no patient-specific probability of progression, recurrence, thrombosis, ulceration, or response to treatment.
verificadoThe 2020 update of the CEAP classification system and reporting standardsLurie et al. 2020, Table III (C2), Clinical working-group discussion items 2-3 (origin and diameter are outside C), and conclusion that CEAP is descriptive rather than a severity/outcome measure.
C2r
4 de 11

C2r, recurrent varicose veins

Recurrent varicose veins after prior treatment. The 2020 recurrence definition includes true recurrence, residual veins, and new varicose veins arising from disease progression after treatment.

CondutaPreserve the r modifier and document the prior intervention, distribution, etiology, anatomy, and reflux or obstruction. Recurrence can alter evaluation and strategy, but C2r alone does not select another procedure.
RiscoC2r distinguishes a potentially different natural history from untreated C2, but CEAP provides no numeric probability of further recurrence, complication, or treatment success.
verificadoThe 2020 update of the CEAP classification system and reporting standardsLurie et al. 2020, Table III (C2r) and Clinical revision subsection 'Subscript for C2 and C6 classes recurrent (r) disease' (scope includes true recurrence, residual veins, and progression after prior treatment).
C3
5 de 11

C3, edema

Edema attributable to chronic venous disease in the classified limb. C3 does not grade the extent, regional distribution, firmness, or phlebolymphedema component.

CondutaDocument laterality, symptom status, distribution, and the separate E/A/P findings; evaluate competing causes of edema rather than assigning venous etiology from swelling alone. CEAP C3 does not prescribe treatment.
RiscoC3 is a broad descriptive class and has no per-limb event probability. It must not be used alone to predict ulceration, response, or need for intervention.
verificadoThe 2020 update of the CEAP classification system and reporting standardsLurie et al. 2020, Table III (C3) and Clinical working-group discussion item 4 (C3 does not encode degree, distribution, induration, or phlebolymphedema).
C4a
6 de 11

C4a, pigmentation or eczema

Pigmentation or eczema attributable to chronic venous disease in the classified limb. Report coexisting C4b or C4c findings separately in advanced CEAP.

CondutaTreat C4a as a skin-manifestation descriptor and complete the venous E/A/P assessment. The label does not identify a responsible segment or mandate a particular intervention.
RiscoC4a denotes skin change associated with chronic venous disease but is not a calibrated ulcer-risk or outcome score and does not imply inevitable progression.
verificadoThe 2020 update of the CEAP classification system and reporting standardsLurie et al. 2020, Table III (C4a) and Clinical revision text retaining pigmentation or eczema as C4a.
C4b
7 de 11

C4b, lipodermatosclerosis or atrophie blanche

Lipodermatosclerosis or atrophie blanche attributable to chronic venous disease in the classified limb. These findings remain grouped as C4b in the 2020 revision.

CondutaDocument the specific skin finding, s or a status, and complete E/A/P characterization. C4b alone does not determine anatomy, pathophysiology, urgency, or treatment choice.
RiscoC4b represents advanced skin and subcutaneous-tissue change, but CEAP supplies no individual ulcer probability or treatment-outcome estimate for this class.
verificadoThe 2020 update of the CEAP classification system and reporting standardsLurie et al. 2020, Table III (C4b) and Clinical revision text retaining lipodermatosclerosis or atrophie blanche as C4b.
C4c
8 de 11

C4c, corona phlebectatica

Corona phlebectatica: a fan-shaped pattern of numerous small intradermal veins on the medial or lateral ankle and foot, also called malleolar or ankle flare. It is a distinct C4 subclass in CEAP 2020 rather than C1.

CondutaReport C4c explicitly, retain any other C manifestations in advanced CEAP, and complete E/A/P characterization. Its presence justifies accurate venous assessment but does not by itself select treatment.
RiscoThe task force placed corona phlebectatica in C4 because it is associated with advanced venous disease and ulcer development; this remains a population association, not an individual numeric forecast.
verificadoThe 2020 update of the CEAP classification system and reporting standardsLurie et al. 2020, Table III (C4c) and Clinical revision subsection 'Addition of corona phlebectatica to the C4 class' (definition, rationale, and association with ulcer development).
C5
9 de 11

C5, healed venous ulcer

Healed venous ulcer in the classified limb, with no currently active venous ulcer. The 2020 C axis has no C5r code; preserve relevant ulcer history separately.

CondutaDocument ulcer site and history, symptom status, and full E/A/P findings when available. C5 describes the current healed state and does not determine prevention, surveillance, or intervention by itself.
RiscoPrior ulceration is clinically important, but CEAP C5 does not provide a calibrated probability of recurrence or benefit from a specific treatment.
verificadoThe 2020 update of the CEAP classification system and reporting standardsLurie et al. 2020, Table III (C5 healed) and Table III recurrence structure, in which r is defined only for C2 and C6.
C6
10 de 11

C6, active venous ulcer

Active venous ulcer in the classified limb without the recurrence modifier. If an active ulcer is known to have recurred after prior healing or treatment, use C6r instead.

CondutaReport the active ulcer and complete wound, clinical, etiologic, anatomic, and pathophysiologic assessment. C6 communicates active ulceration but does not replace wound evaluation or prescribe a venous intervention.
RiscoC6 identifies active ulcer disease but does not quantify healing time, recurrence, infection, limb risk, or treatment response for an individual patient.
verificadoThe 2020 update of the CEAP classification system and reporting standardsLurie et al. 2020, Table III (C6 active venous ulcer) and recurrence subsection distinguishing C6r.
C6r
11 de 11

C6r, recurrent active venous ulcer

Recurrent active venous ulcer in the classified limb. Apply r only when recurrence is established; an active ulcer with unknown prior healing or treatment history should not be upgraded automatically to C6r.

CondutaPreserve recurrence history and complete the wound plus E/A/P description, including the veins associated with reflux or obstruction. C6r can affect clinical strategy but does not select treatment on its own.
RiscoC6r distinguishes recurrent from first-recorded active ulceration and may reflect a different natural history, but it is not a calibrated recurrence, healing, or complication score.
verificadoThe 2020 update of the CEAP classification system and reporting standardsLurie et al. 2020, Table III (C6r) and Clinical revision subsection 'Subscript for C2 and C6 classes recurrent (r) disease.'
Lógica de decisão estruturada

Classify each limb independently. Keep the complete CEAP tuple when the evidence supports it; never turn the ordered C labels into a numeric severity score or infer E/A/P from appearance alone.

{
  "categories": [
    {
      "outcome_code": "C0",
      "finding": "no_visible_or_palpable_signs_of_venous_disease"
    },
    {
      "outcome_code": "C1",
      "finding": "telangiectasias_or_reticular_veins"
    },
    {
      "outcome_code": "C2",
      "finding": "varicose_veins"
    },
    {
      "outcome_code": "C2r",
      "finding": "recurrent_varicose_veins_after_prior_treatment"
    },
    {
      "outcome_code": "C3",
      "finding": "edema_attributable_to_venous_disease"
    },
    {
      "outcome_code": "C4a",
      "finding": "pigmentation_or_venous_eczema"
    },
    {
      "outcome_code": "C4b",
      "finding": "lipodermatosclerosis_or_atrophie_blanche"
    },
    {
      "outcome_code": "C4c",
      "finding": "corona_phlebectatica"
    },
    {
      "outcome_code": "C5",
      "finding": "healed_venous_ulcer"
    },
    {
      "outcome_code": "C6",
      "finding": "active_venous_ulcer"
    },
    {
      "outcome_code": "C6r",
      "finding": "recurrent_active_venous_ulcer"
    }
  ],
  "applicability": {
    "use_for": "Description of chronic venous disorders of the lower extremities, one limb at a time.",
    "classification_unit": "right_or_left_lower_extremity",
    "required_inputs": [
      "limb_side",
      "all_present_clinical_signs",
      "symptoms_attributable_to_venous_disease",
      "prior_treatment_and_recurrence_status"
    ],
    "add_for_full_CEAP": [
      "etiology",
      "anatomic_venous_compartment_or_segments",
      "reflux_or_obstruction_by_segment",
      "classification_date"
    ],
    "outside_scope": [
      "isolated_pelvic_or_abdominal_venous_disorders_without_lower_extremity_manifestations",
      "acute_venous_thrombosis_staging",
      "treatment_response_scoring"
    ]
  },
  "clinical_axis": {
    "basic_CEAP": "Report the single highest numbered C class present in that limb, retaining an applicable subclass or recurrence modifier.",
    "advanced_CEAP": "Report every C class present in that limb; do not discard coexisting manifestations.",
    "symptom_suffix": {
      "s": "symptoms_attributable_to_venous_disease_present",
      "a": "symptoms_attributable_to_venous_disease_absent"
    },
    "recurrence_modifier": {
      "allowed_with": [
        "C2r",
        "C6r"
      ],
      "C2r_scope": [
        "true_recurrence",
        "residual_varicose_veins",
        "new_varicose_veins_from_progression_after_prior_treatment"
      ],
      "C6r_scope": "active_venous_ulcer_that_has_recurred"
    },
    "nonadditivity_rule": "C findings need not appear sequentially. The numeric ordering must not be interpreted as a linear severity scale or inevitable disease progression.",
    "same_level_rule": "C4a, C4b and C4c are distinct C4 manifestations; if more than one is present, retain all of them in advanced CEAP rather than inventing a severity order among the subclasses."
  },
  "full_CEAP_axes": {
    "E_etiology": [
      {
        "code": "Ep",
        "meaning": "primary"
      },
      {
        "code": "Es",
        "meaning": "secondary_umbrella"
      },
      {
        "code": "Esi",
        "meaning": "secondary_intravenous_with_venous_wall_or_valve_damage"
      },
      {
        "code": "Ese",
        "meaning": "secondary_extravenous_hemodynamic_cause_without_required_wall_or_valve_damage"
      },
      {
        "code": "Ec",
        "meaning": "congenital"
      },
      {
        "code": "En",
        "meaning": "no_cause_identified_after_exclusion_of_other_E_categories"
      }
    ],
    "A_anatomy_basic": [
      {
        "code": "As",
        "meaning": "superficial_veins"
      },
      {
        "code": "Ad",
        "meaning": "deep_veins"
      },
      {
        "code": "Ap",
        "meaning": "perforator_veins"
      },
      {
        "code": "An",
        "meaning": "no_venous_anatomic_location_identified"
      }
    ],
    "A_anatomy_advanced_abbreviations": {
      "superficial": [
        "Tel",
        "Ret",
        "GSVa",
        "GSVb",
        "SSV",
        "AASV",
        "NSV"
      ],
      "deep": [
        "IVC",
        "CIV",
        "IIV",
        "EIV",
        "PELV",
        "CFV",
        "DFV",
        "FV",
        "POPV",
        "TIBV",
        "PRV",
        "ATV",
        "PTV",
        "MUSV",
        "GAV",
        "SOV"
      ],
      "perforator": [
        "TPV",
        "CPV"
      ]
    },
    "P_pathophysiology_basic": [
      {
        "code": "Pr",
        "meaning": "reflux"
      },
      {
        "code": "Po",
        "meaning": "obstruction"
      },
      {
        "code": "Pr,o",
        "meaning": "reflux_and_obstruction"
      },
      {
        "code": "Pn",
        "meaning": "no_venous_pathophysiology_identified"
      }
    ],
    "advanced_linkage_rule": "Attach each specific anatomic abbreviation to its demonstrated pathophysiology, for example Pr(GSVa,GSVb) and Po(CIV); do not infer E, A or P from the C class alone."
  },
  "output_contract": [
    "identify_right_or_left_limb",
    "state_basic_or_advanced_CEAP",
    "report_C_code_or_codes_with_s_or_a_suffix",
    "preserve_r_only_for_C2r_or_C6r_when_recurrence_is_established",
    "for_full_CEAP_report_E_A_and_P_separately",
    "for_advanced_P_link_each_named_vein_to_reflux_or_obstruction",
    "record_classification_date"
  ],
  "missing_input_behavior": [
    "Do not label C2r or C6r when prior treatment or recurrence status is unknown; retain the observable non-r category and flag recurrence status as unresolved.",
    "Do not infer symptoms from imaging or infer reflux, obstruction, etiology or anatomic distribution from the clinical C class.",
    "If clinical examination is unavailable, do not manufacture a C class from duplex findings alone."
  ],
  "interpretation_limits": [
    "CEAP is descriptive; it does not measure change over time, prescribe treatment, or replace the Venous Clinical Severity Score when a severity or longitudinal instrument is required.",
    "A C class alone is an incomplete CEAP description and cannot establish the responsible vein, etiology, reflux, obstruction or procedural target."
  ],
  "source_locator": "Lurie et al., 2020 CEAP update, DOI 10.1016/j.jvsv.2019.12.075: Table III and Clinical revision text for C0-C6r, basic versus advanced C and s/a; Tables IV-VI for E, A and P; Anatomic and Pathophysiologic revision sections for limb side and advanced segment linkage."
}

Referência, não é dispositivo médico. Confira a publicação primária vigente. O radiologista que assina o laudo continua autor e responsável.