One of the more dramatic incidents that can happen to our patients is an episode of spontaneous high pressure bleeding from a leg vein.
Elevated pressure in leg veins is secondary to a vein blockage or more commonly due to failure of the many valves inside the major leg veins. This often exists without significant symptoms. In this case, varicose veins just below the skin surface or large spider veins under high pressure are often present without complaints of local throbbing, leg heaviness or ankle swelling. Bleeding can occur with mild trauma to the vein, even a light scratch. Warm water in the shower or bath has been suggested as a promoter of bleeding episodes but the culprit vein is invariably found to be under high pressure and is weak due to its thinned out walls. Eventually, the walls erode through thin skin and the vein ruptures. The fact that so many patients are now on a variety of blood thinners increases these bleeding risks.
Blood loss can be substantial as blood often ejects from the leg as if the source is an artery. Locally applied finger pressure along with leg elevation is the first measure indicated for bleeding control. However, it is very difficult for an older individual by themselves to perform both maneuvers and call for help. For that reason it is not surprising that blood loss can be significant. Finally, an episode that occurs while a person is sleeping can be especially dangerous as the bleeding is painless and the patient is often unaware they are losing blood.
Proper investigation and treatment of vein bleeding is straight forward. First, local temporary control often by a doctor placing a suture around the vein is recommended since re-bleeding is common if only local pressure application is attempted. Once bleeding is controlled, evaluation of the patient’s vein anatomy with an ultrasound exam is needed. Determining the anatomy and blood flow pattern of the deep, superficial and perforator veins of the affected leg is necessary and often requires a portion of the exam to be performed while the patient stands. This type of exam is not routinely performed in an imaging center unless a specific request is made by your doctor. At Vein Specialists of Tampa, all of our ultrasound exams are performed in this comprehensive manner.
Once the ultrasound findings are known, definitive treatment typically involves local injection of the culprit vein and its surrounding veins with pharmaceutical grade sclerosing medications. This closes and scars down the surface vein that bled. When the diagnostic ultrasound confirms “vein insufficiency” as the source of the higher pressure, it is recommended that a portion of venous system be closed by usually one of several techniques (eg. laser).
Definitive treatment that addresses both the high pressure in the vein with laser and the local vein wall erosion with sclerotherapy are the optimal therapies to prevent recurrent venous bleeding.
If you are suffering from large, bulging, painful varicose veins, schedule your consultation with Dr. Dworkin today.
