CEAP Classification in Practice: Correct Coding and Formulation in Ultrasound Reporting
Four Domains of CEAP
CEAP allows for detailed documentation of the disease status at a specific point in time within four domains: clinical, etiological, anatomical, and pathophysiological (ESVS 2024). It is the most common descriptive tool for chronic venous diseases and disorders.
Pathophysiological Domain (P)
The pathophysiological classification describes two main chronic abnormalities (isolated or combined) and a class without apparent findings:
| Code | Value |
|---|---|
| Pr | Reflux (reverse venous flow) |
| Po | Chronic venous obstruction |
| Pr,o (Pro) | Pathological combination of reflux and obstruction |
| Pn | Pathophysiology not identified |
For the anatomical domain, the code An is also provided — venous anatomy not identified.
Basic and Extended CEAP
There is a distinction between basic CEAP (highest C-class + E/A/P in general terms — minimum information sufficient for routine) and extended (comprehensive) CEAP (specific veins, level, date, method — for clinical decisions and scientific work).
What Changed in CEAP 2020
The latest revision is CEAP 2020 (Lurie et al., update of the American Venous Forum task force). Compared to the 2004 version, letter abbreviations of anatomy were introduced instead of numbers: previously, veins were coded with numbers A1–A18, now common abbreviations of specific veins are used.
Examples of Formulations for Ultrasound Reporting
Basic CEAP: “C3, s; Ep; As, Ap; Pr” — symptomatic edema (C3s), primary etiology (Ep), superficial veins and perforators affected (As, Ap), mechanism — reflux (Pr).
Extended (comprehensive) CEAP of the same case: “C3, s; Ep; As (GSV thigh), Ap (mid-calf perforator); Pr; 2024-06-01; L1 (duplex)” — specifying particular veins, date, and level/method.
Post-thrombotic example: “C5, s; Es,i; Ad (popliteal); Po” — healed ulcerative defect, secondary intravascular (post-thrombotic) etiology, deep system (popliteal), mechanism — obstruction.
Supplement to CEAP
CEAP is a descriptive classification. For quantitative assessment, the Venous Clinical Severity Score (VCSS) is used, which provides a numerical, measurable index applicable for monitoring the patient over time and evaluating treatment outcomes.
Frequently asked questions
How does basic CEAP differ from extended?
Basic CEAP includes the highest C-class and E/A/P in general terms — the minimum for routine. Extended (comprehensive) specifies particular veins, level, date, and method — for clinical decisions and scientific work.
What codes are used in the pathophysiological domain?
Pr — reflux, Po — chronic venous obstruction, Pr,o (Pro) — their combination, Pn — pathophysiology not identified.
What changed in CEAP 2020 compared to the 2004 version?
Instead of numerical anatomy codes A1–A18, letter abbreviations of specific veins were introduced (Lurie et al., 2020).
How to record anatomy when no identifiable venous structure is present?
The code An is used — venous anatomy not identified.
How to assess disease severity over time if CEAP is descriptive?
The VCSS (Venous Clinical Severity Score) is used — a numerical quantitative index for monitoring the patient over time and evaluating treatment outcomes.