Spontaneous Hemorrhage from Varicose Veins: A Single-Center Experience

What does that mean for my veins?

This research study addresses the problem of bleeding from varicose veins. Thankfully, this is a very uncommon problem, but when it occurs the bleeding can be quite dramatic, and in some cases life-threatening.

At the very busy Vascular Institute of New York in Brooklyn, over a 29-month period they saw 808 new patients with varicose veins of whom 32 (3.9%) presented with bleeding from the varicose veins. All of the patients were treated successfully.

After reviewing their research report I summarize the key “take-home” messages as follows:

  1. Thankfully, significant bleeding from varicose veins is very uncommon.
  2. The authors found that exposure to warm water, such as in the shower, often preceded the bleeding. The thought is that the warmth causes the small blood vessels beneath the skin to dilate which might have increased the risk of bleeding. (By no means though is this an admonishment against cleanliness and hygiene for those who have varicose veins!)
  3. The initial treatment of this bleeding is very important. These details were not addressed specifically in their report, but this is the most important aspect of the care and I emphasize when educating my patients. Initial first aid is critical –  elevate the leg, call for help, and hold pressure against the bleeding area to help stop the bleeding. Leg elevation is a key component to the initial treatment. By elevating the legs, gravity causes the low-pressure blood in the veins to drain back up to the body and thereby decreasing the pressure within the veins. This maneuver alone will usually stop the bleeding. Since the bleeding can be rather dramatic, a natural tendency is to panic and run around seeking help. Don’t run or stand! This will increase the pressure in the veins (by gravity) and worsen the bleeding. Since the bleeding often occurs while in the shower, I advise my patients to lay down on the bathroom floor and prop their legs up on the edge of the tub, or if possible, prop them higher on the edge of the vanity to allow gravity to empty the veins and stop the bleeding.
  4. The small “sore” at the site of bleeding was treated with a special wound care bandage called an Unna Boot. Use of the Unna Boot for 2-4 weeks allowed the sore to heal.
  5. None of their 32 patients with bleeding varicose veins had to be admitted to the hospital and none required a blood transfusion.
  6. Almost all of their patients with bleeding veins were later tested with ultrasound and found to have abnormal vein reflux, or “backwards” flow in the veins. This is caused by dysfunction, or “leaking”, of the tiny one-way valves in the leg veins that normally keep the blood flowing only in one direction – back up the leg and to the heart. When these valves wear out, the result is increased pressure on the leg veins which then can lead to developing large, bulging varicose veins. These patients were then treated with ablation procedures (a minimally-invasive procedure that we perform almost every day in the office) to close the vein with the “leaking” valves. This reduces the pressure in the veins which allows the varicose veins to fade away and the small bleeding area to heal.

Mark R. Jackson, M.D.
Board Certified Vascular Surgeon

* Original article “Spontaneous hemorrhage from varicose veins: A single-center experience” published in January 2020 by authors Amrit Hingorani; Jesse Chait, BS; Pavel Kibrik, DO; Ahmad Alsheekh, MD; Natalie Marks, MD; Sareh Rajaee, MD; Anil Hingorani, MD; EnricoAscher, MD.
Original citation: Journal of Vascular Surgery: Venous and Lymphatic Disorders. Volume 8, Issue 1, January 2020, Pages 106-109

Meet Dr. Jackson

Carolina Vein Care | Vein Specialists in Greenville, SC | Varicose Veins, Spider Veins, Reticular Veins | Team Headshots | Mark R. Jackson, MD

Dr. Jackson then moved to Greenville in 2003 where he has practiced vascular surgery, started the vascular surgery program at St. Francis Hospital which in 2015 was recognized as a HealthGrades Top 50 Hospital in Vascular Surgery. Dr. Jackson has now started a new, independent medical practice with Dr. Julie Park specializing in the treatment of venous disorders such as varicose veins of the legs.