by Adam Karalus (Physician Assistant Student at Daemen College)
Hemorrhage from varicose veins is another variant for presentation in chronic venous insufficiency. The classic end results of venous insufficiency are recognized as development of varicose veins, extremity swelling, skin changes (trophic changes) and lower extremity venous stasis ulcer formation.
Hingorini and colleagues have investigated their single-center experience for patients with varicose veins that present following a spontaneous bleeding episode.
The authors found that alf of their patient cohort reported varicose vein hemorrhage during or directly after coming into contact with warm water. Furthermore, these patients demonstrated a significantly shorter wound healing time compared with the rest of the cohort. They use UNNA compression boots to help heal the wounds.
Patients with hemorrhage (from varicose veins) after contact with warm water had a mean healing time of 1.75 weeks (for thier wound), whereas those who bled without such exposure took an average of 3.5 weeks. Twenty patients underwent at least one endovenous thermal ablation procedure, with the average patient in the cohort receiving 2.16 procedures.
They concluded that "basic first aid, wound care, and hemostasis control education should be provided to all patients who present with hemorrhage from varicose veins"
Hingorani A, Chait J, Kibrik P, Alsheekh A, Marks N, Rajaee S, Hingorani A, Ascher E. Spontaneous hemorrhage from varicose veins: A single-center experience. J Vasc Surg Venous Lymphat Disord 2020; 8: 106-109.
Dr Karamanoukian's comment: My experience has been similar in that a significant number of patients report having this episode of hemorrhage from varicose veins while in the shower. However, our experience differs in that very few of our patients need UNNA boots for ulcer formation following a bleeding episode. Most patients stop the bleeding with digital control or present to the emergency room where a single suture is placed to sto the hemorrhage and present to our office within a week.