Management of external hemorrhage from varicose veins

In the thirty-six-month period after October 1, 1992, 20 patients were seen who experienced profuse external hemorrhage from subcutaneous varicose veins or intracutaneous telangiectasias, These were, for the most part, elderly, the 11 women averaging 68.9 years of age, and the 8 men (exclusive of a fourteen-year-old boy) averaging 58.6 years of age. None of the episodes of bleeding occurred in patients with venous ulcer, and trauma was not a factor in producing bleeding. The bleeding was characterized by high-pressure jet effect, which caused a fountain-like hemorrhage to occur. Hemorrhage was stopped by local pressure, and definitive treatment was by sclerotherapy, surgical removal of sources of venous hypertension, or combinations of these. Continuous-wave Doppler evaluation assisted in selecting patients for surgery, and duplex ultrasound provided information that guided the surgical events. A complete review of previously reported cases suggests this is a dangerous and not trivial complication of venous hypertension and varicosities. Suggested management is outlined.