A 55-year-old woman presents with swollen, heavy left leg and varicose veins. Duplex ultrasound confirms great saphenous vein (GSV) incompetence with sapheno-femoral junction (SFJ) reflux. The CEAP classification scores clinical severity. She has skin hyperpigmentation and lipodermatosclerosis without active ulcer. What CEAP clinical class is she?

• A CEAP C3
• B CEAP C5
• C CEAP C6
• D CEAP C4b ✓

Explanation

CEAP clinical classification: C0 = no signs; C1 = telangiectasias/reticular veins; C2 = varicose veins; C3 = oedema; C4a = pigmentation or eczema; C4b = lipodermatosclerosis or atrophie blanche; C5 = healed venous ulcer; C6 = active venous ulcer. Lipodermatosclerosis is specifically classified as C4b (not C4a, which covers hyperpigmentation and eczema). This distinction is clinically important as C4b has a high risk of progression to active ulceration. Options for treatment include endovenous thermal ablation (EVLA/RFA) or foam sclerotherapy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.