How bad is my vein disease?

By Reeder Vein Institute
January 5, 2015

Keywords: chronic venous disease, chronic venous insufficiency, spider veins, varicose veins, venous ulceration, inflammation, CEAP classification 

Vein disease is often visible and often recognized by patients when they have the appearance of visibly abnormal varicose veins, or spider veins. Patients often ask, “how bad is my vein disease?

In 1994 an international committee of experts in vein disease proposed the CEAP classification of venous disease. The CEAP classification was revised in 2004, and is currently used worldwide to classify the stage, or progression, of vein disease. The C in the system is based on the clinical manifestations, that is, what is visible to the examiner. This includes small veins in the skin (spider veins), small blue veins beneath the skin called reticular veins, larger bulging varicose veins, swelling of the leg (edema), skin changes of brown discoloration or reddish inflammation, or skin breakdown, termed venous ulceration. These visible findings place the vein patient into one of six categories, each representing a worsening in the severity of the vein disease. These categories are summarized as follows:

C1 Spider or reticular veins

C2 Varicose veins

C3 Edema

C4 Skin changes including tan or brown staining of the skin, inflammation (redness), or scarring of the skin as a result of chronic inflammation

C5 Healed venous ulcer

C6 Active open venous ulcer (skin breakdown)

CEAP 3-6 is represents vein disease and is often termed chronic venous insufficiency.  CEAP 4 is a pivotal point in  advanced venous disease with many CEAP 4 patients progressing to CEAP 6 disease (skin ulceration) over time. The CEAP stage also determines the urgency of treatment. In general, most health insurance plans cover the treatment of CEAP 2 disease or greater if symptoms are present. Treatment of CEAP stages 3-6 is almost always covered by health insurance plans.

Symptoms associated with vein disease include heaviness, fatigue, restlessness, aching discomfort, and itching. The symptoms occur most often in the lower legs, and skin changes occur most commonly just above the ankle, especially common on the inner aspect of the lower leg.  In advanced disease the skin changes may involve the entire circumference of the lower leg.  Once skin changes occur, the need to treat the vein disease becomes more urgent, especially if there is significant inflammation (redness) in the skin.

Fortunately, most forms of venous disease are treated very successfully with minimally invasive procedures, which correct the venous circulation to a healthy state, and relieve the symptoms. Treatment also restores the appearance of the legs to a more normal and healthy condition.  You can read more about treatment of these conditions on our website at

Chronic Venous Disease (CVD)


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