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Located very near the surface of the skin, varicose veins may rupture and bleed spontaneously or due to a very minor injury to the skin.  Often, the veins which bleed spontaneously are small veins near the ankle and they do not necessarily cause pain or tenderness.  Venous pressures inside some varicose veins near the ankle or foot can be nearly as high as arterial blood pressure due to the effect of gravity and failure of valves in veins at multiple levels in the legs.  The very high pressures within the veins may stretch the walls of the veins causing weakness over time.  The vein may rupture very suddenly causing bleeding into the tissues or through the surface of the skin if the skin has become thin overlying the vein.

Bleeding varicose veins may be small amounts on sporadic occasions or it may be life-threatening with blood squirting many feet across the room.

Emergency treatment for bleeding from a varicose vein is simple:

  • Elevate the leg higher than the heart, and
  • Apply pressure over the bleeding site.  This may be done initially with a finger to control the bleeding followed by a pressure dressing.  A folded gauze sponge or a cloth applied over the site with pressure from compression hose or an elastic wrap usually work well to prevent repeat bleeding for the short term.

Ultrasound guided sclerotherapy has proven to be one of the best treatments to prevent repeat bleeding episodes.  Complete evaluation of the veins of the lower extremity is important to find the underlying causes of the problem for definitive treatment.

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