The 6 stages of varicose veins
C1 · Spider or reticular veins
C2 · Varicose veins
C3 · Edema
C4 · Skin changes
C5 · Healed venous ulcer
C6 · Active venous ulcer
ENGLISH
CEAP is a shared clinical language for describing chronic venous disease. C1 begins with spider or reticular veins, while C6 represents an active venous ulcer.
The stage does not decide treatment by itself. Symptoms, ultrasound findings and impact on daily life should be considered together.
- C1 spider or reticular veins
- C2 varicose veins
- C3 edema
- C4 skin changes
- C5 healed venous ulcer
- C6 active venous ulcer
1.C1–C2: visible vein changes
- C1: small spider or reticular veins.
- C2: enlarged, twisted, prominent subcutaneous veins.
- Visible appearance and symptom severity do not always match.
2.C3–C4: swelling and skin changes
- C3: ankle or lower-leg edema, often worse later in the day.
- C4: pigmentation, eczema, induration or skin atrophy.
- Earlier assessment is advisable when skin changes appear.
3.C5–C6: venous ulcers
- C5: a previous venous ulcer that has healed.
- C6: a current active venous ulcer.
- Wound care and underlying venous hypertension both need attention.
💡 CEAP C1–C6 at a glance
| Stage | Main finding | Suggested step |
|---|---|---|
| C1 | Spider or reticular veins | Discuss appearance and symptoms |
| C2 | Varicose veins | Consider ultrasound |
| C3 | Edema | Assess venous and other causes |
| C4 | Pigmentation, eczema or induration | Seek earlier treatment advice |
| C5 | Healed venous ulcer | Prevent recurrence |
| C6 | Active venous ulcer | Treat the wound and venous disease |
Note: C4 skin changes, a healed C5 ulcer or an active C6 ulcer deserves vascular and wound assessment.
References
- De Maeseneer MG, et al. ESVS 2022 Clinical Practice Guidelines. Eur J Vasc Endovasc Surg. 2022;63:184–267. View source
This article is for health education only and does not replace individual medical assessment. Seek urgent care for acute symptoms.
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