Management of sudden profuse bleeding from varicose veins

Varicose vein bleeding of the lower extremities is an unusual but pressing indication for treatment and can be lethal. This series reviews operative and injection treatment of such veins in patients with bleeding. During a 49-month period 14 patients (eight men and six women) with a mean age of 62.1 years (range, 23 to 93 years) were seen after venous bleeding related to varicosities of the lower extremity. They described between one and five episodes of bleeding (mean, 2.4), but only one patient required transfusion. The site of bleeding was the lower calf or foot in 11 and affected the thigh in three patients. One was in the third trimester of pregnancy. Nine patients had lesions involving clustered small 1 mm or less diameter varicose veins, whereas five had large diffuse varicose vein formation. None had evidence of coagulopathy, and the inciting episode was either unknown or related to minor trauma. Treatment of eight patients with small-diameter veins was instituted with 0.2% sodium tetradecyl injection with a 30-gauge needle, thrombosing veins within 5 cm of the bleeding focus. A total of 13 ml solution (1.0 to 27 ml) per patient was used during two or three treatment periods (mean, 2.5 treatment periods) spaced 2 weeks apart. Six patients were treated by means of standard vein-stripping techniques or local branch removal at the bleeding site. Effective thrombosis was achieved in all eight patients with small (less than 1 mm) varicose veins treated with sclerosis. In five patients who underwent surgery there was effective resolution of the hemorrhage. One patient with small-diameter varicose veins clustered about the ankle underwent operative treatment and had venous stasis ulceration requiring compression dressings for healing. In all 14 cases control of bleeding was obtained, with follow-up to 49 months (mean, 21.3 months); one had rebleeding from a site 32 cm remote from the original injected area 11 months after treatment. Bleeding from small-diameter varicose veins of the lower extremity can be controlled effectively by sclerosing techniques with sodium tetradecyl. Larger veins are managed with operative removal. Combining these techniques provides efficient management of often-elderly patients, many in an outpatient setting.