Diagram - Symptoms of Varicose Veins

CEAP – How Bad Are Your Varicose Veins?

If you have varicose veins and are hoping to get some kind of treatment, then it helps to understand how bad your veins are.

Varicose veins are classified according to CEAP classification. This is the official way of classifying the severity of varicose veins; which in turn, helps to determine what sort of treatment is most appropriate.

CEAP System for Varicose Veins

The CEAP system was created by a committee of the American Venous Forum in 1994  The objective was to standardise the reporting of varicose veins so that diagnosis and treatment can be more uniform. The classifications were updated in 2004 and revised again in 2020 to improve the system.

The classification offers clinicians a choice of 7 stages of varicose vein and some of these also have sub-stages. The severity of varicose veins helps to establish the best treatment option.

Stage Description Treatment
C0 No visible or palpable signs of venous disease Lifestyle advice i.e. diet/exercise, to slow progression of varicose veins. This is sensible at all stages.
C1 Visible veins or blood vessels beneath the skin surface, which do not bulge. These may include red spider veins/telangiectasias as well as blue/purple veins Potentially compression stockings in addition to lifestyle advice
C2 Varicose veins are visible – raised/protruding May consider sclerotherapy injections at this stage in addition to above
C3 Swelling or swollen varicose veins (oedema) caused by water retention May consider treatments such as EVLA or ClariVein
C4 Changes to skin quality and appearance

  • C4a – surface skin conditions e.g. pigmentation, eczema
  • C4b – more severe associated skin conditions e.g. changes to skin texture
  • C4c – visible veins and vessels around the ankles
Treatment of varicose veins here could help to avoid developing leg ulcers.
C5 Varicose veins with healed ulcers Treatment of varicose veins at this point could help to prevent further leg ulcers from developing
C6 Varicose veins with active/open ulcers, which can be very painful Once a leg ulcer has been present for two weeks or more, then a referral to a specialist vascular service is recommended

Lifestyle changes and compression stockings are intended to keep varicose veins at the lower stages and to slow down the progression. This reduces the risk of developing more serious complications, which can be uncomfortable and painful as well as unsightly.

How the NHS use CEAP Guidelines

Classifying your varicose veins according to the above system enables doctors to determine at what point a patient may be referred. The NHS guidelines  at https://www.nice.org.uk/guidance/cg168/documents/varicose-veins-full-version-2 state:

1.2 Referral to a vascular service

1.2.1 Refer people with bleeding varicose veins to a vascular service immediately.

1.2.2 Refer people to a vascular service if they have any of the following.

    • Symptomatic primary or symptomatic recurrent varicose veins.
    • Lower‑limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency.
    • Superficial vein thrombosis (characterised by the appearance of hard, painful veins) and suspected venous incompetence.
    • A venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks).
    • A healed venous leg ulcer.

Unfortunately, this means the NHS effectively waits for the condition to deteriorate before funding treatment. Earlier stages can be unpleasant, but they are not considered severe enough until there are advanced issues such as skin changes, bleeding or ulcers.

Varicose Vein Treatment UK

Varicose veins are not a condition that will go away without treatment, so many people are now turning to the private sector for treatment, to enjoy healthier skin and veins earlier and avoid the difficulties of the more advanced CVI (Chronic Vein Insufficiency) disease.

Varicose Vein Removal

The only really effective way to resolve varicose veins for good is with surgery. However, that doesn’t have to mean painful vein stripping with a long recovery. Modern varicose vein surgery is provided in private clinics on a day case basis using laser technology which offers excellent results and fast recovery.

Cosmedics Skin Clinics offer private EVLA (endovenous laser ablation) laser varicose vein removal at their London vein treatment centre with a renowned vascular surgeon with prices starting at £1,650 per leg (1 vein). There is no general anaesthetic, no hospital stay and patients can walk out of the clinic with the varicose veins gone.

They also offer foam sclerotherapy and micro surgery in order to provide a tailor-made service with the most appropriate treatment for each individual.

For more information or to book a consultation, please complete the form on this web page or call 020 7386 0464.

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