Management of Bleeding Varicose Veins

Table of Contents

Varicose veins (VV) are a very common symptom of chronic venous disease
Bleeding from varicose veins is a potentially life-threatening complication
The risk of bleeding increases if there is atrophic skin over the varicose veins, varicose blisters, or if the veins are located under an ulcer
If a varicose vein ruptures, the bleeding can be substantial and potentially life-threatening
Even after initial bleeding is controlled, patients who do not receive treatment for varicose veins are at risk of recurrent bleeding

Apply support and elevate the leg
Apply pressure to the bleeding site using pads and compression bandages, if possible
If there is significant blood loss, consider fluid resuscitation (transfusion if needed) and reapplication of compression to the bleeding varicose vein if initial compression is inadequate
Urgent referral to a vascular specialist is recommended
- Perform urgent venous duplex ultrasound imaging for early treatment of underlying chronic venous disease
- Imaging studies should rule out other causes of bleeding, such as arteriovenous malformations, fistulas, vascular tumors, or arterial collaterals
- Consider endovascular intervention or sclerotherapy

A 55-year-old woman was found dead at home with evidence of extensive bleeding
The only identified cause was a nearly 4mm ruptured varicose vein on the posteromedial aspect of her right leg, located 10 cm below the medial femoral epicondyle. There were moderate superficial varicose veins on both legs
Acute perforation typically occurs in superficial veins around the medial malleolus. The most distal lesion location is the medial arch of the foot

Type bⅠ: Rupture of an expanded varicose segment leading to massive bleeding
- This occurs due to venous thrombosis and skin inflammation, making the vein more vulnerable to external rupture. Increased intravenous pressure in superficial leg veins, due to cardiac dysfunction or deep vein thrombosis (DVT), contributes to this condition
Type bⅡ: Preceded by erosion of a large vein beneath a chronic skin ulcer