Stages of Varicose Veins: Degrees and CEAP Classification

In the phlebologist's report you see an entry such as "C2". This is a designation from the international classification that describes how far varicose veins have progressed. Let's break down what the stages and classes mean.

Varicose veins: what it is and why stages are distinguished

Varicose veins are a venous disorder in which the lumen of the vessel widens, the wall thins, and "nodes" form — local dilations. The veins of the legs are most often affected. Veins have valves that keep blood moving toward the heart. If the valves are weakened or damaged, blood stagnates and the veins swell. The disease develops slowly, over years, so doctors divide it into stages: this makes it clear what is happening now and what to expect next.

Stages of varicose veins: how the manifestations change

The CEAP classification distinguishes six stages. At stage 0 there are complaints, but no dilated veins are visible on examination. At stage 1, vascular "spider veins" or a network appear on the skin. Stage 2 is "true" varicose veins: enlarged veins or nodules filled with blood; they may become more noticeable after prolonged sitting. At stage 3, edema is added, usually by the end of the day; overnight it decreases or disappears. Stage 4 is trophic changes: the skin darkens due to pigment accumulation, inflammation develops, and in severe cases skin atrophy and trophic ulcers occur. Stage 5 differs from stage 4 by healed ulcers, and stage 6 by at least one unhealed ulcer.

CEAP classification and class C2: what the designations mean

The name CEAP is made up of the first letters of the words Clinical, Etiology, Anatomy, Pathology. Class C2 corresponds to stage 2 — "true" varicose veins, in which the likelihood of thrombus formation is increased.

Advanced varicose veins: signs and complications

Stages 4–6 describe trophic skin changes and ulcers. The skin on the lower leg darkens, becomes inflamed, dry, and flaky. At stage 5 the ulcers have already healed; at stage 6 there is at least one unhealed ulcer. Typical symptoms include edema, heaviness and pain in the legs, night cramps, itching and skin discoloration, and swelling of the feet and lower legs. Symptoms worsen after prolonged standing and subside at rest with the legs elevated.

How the doctor determines the degree of varicose veins

The diagnosis is often made on examination. Duplex ultrasound scanning may additionally be needed — it checks blood flow and helps plan treatment. In some cases, venography is used — a study of blood flow in the veins. Based on the results, the doctor assigns the CEAP class.

When a consultation with a surgeon or phlebologist is needed

You should see a doctor if there is pain, itching, or swelling in the legs, if an ulcer has appeared on the leg that does not heal for two weeks, or if the veins are getting worse. Emergency care is required for bleeding from a varicose vein.

• Pain, heaviness, itching, or swelling in the legs
• An ulcer on the leg that does not heal for more than two weeks
• Noticeable worsening of the appearance of the veins
• Bleeding from a dilated vein

Varicose veins by themselves are not a reason to call an ambulance. Call 103 or 112 if there is bleeding from a varicose vein.

This material is for reference: only a doctor can determine the stage and choose the treatment approach after an examination and testing.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer