Venous ulceration and the CEAP classification

What it is

Venous ulceration is typically seen above the medial malleolus.

How it is diagnosed

The ankle-brachial pressure index, ABPI, is important in non-healing ulcers to assess for poor arterial flow which could impair healing. A normal ABPI may be regarded as between 0.9 and 1.2. Values below 0.9 indicate arterial disease. Values above 1.3 may also indicate arterial disease, in the form of false-negative results secondary to arterial calcification, for example in diabetics.

The classification used for this lesion has four axes, and each class on them carries a label, which is how the classification is used:

• Clinical: C0, no clinical signs; C1, small varicose veins; C2, large varicose veins; C3, edema; C4, skin changes without ulceration; C5, skin changes with healed ulceration; C6, skin changes with active ulceration
• Etiology: Ec, congenital; Ep, primary; Es, secondary, usually due to prior DVT
• Anatomy: As, superficial veins; Ad, deep veins; Ap, perforating veins
• Pathophysiology: Pr, reflux; Po, obstruction

The clinical classes are also given with examples, that is with what each one looks like on a leg. C1 is telangiectasias or reticular veins. C2 is varicose veins. C3 is edema and corona. C4, the skin changes without ulceration, is lipodermato-sclerosis and eczema. C5 is ulcer scar, and C6 is active ulcer, so an active venous ulcer is C6.