Varicose veins are swollen, twisted vessels that occur when valves inside the leg veins fail, causing blood to pool and the vein to enlarge. While often considered a cosmetic concern, a rupture leading to external bleeding is a serious event that demands immediate attention. Bleeding from a varicose vein can be dangerous because the veins are located just beneath the skin and are under high internal pressure. This combination allows for rapid and significant blood loss, which can be alarming and potentially life-threatening if not controlled quickly.
Immediate Steps When Bleeding Occurs
The immediate priority when a varicose vein begins to bleed is to stop the flow of blood. The first step is to sit or lie down and immediately elevate the affected leg above the level of the heart. Elevating the limb uses gravity to reduce the high venous pressure within the ruptured vein, which helps to slow the bleeding.
Next, apply firm, continuous pressure directly onto the bleeding site using a clean cloth or sterile gauze. Maintain this steady, uninterrupted pressure for a minimum of 10 to 15 minutes to allow a clot to form inside the vein. Avoid checking the wound during this time, as lifting the cloth can dislodge a forming clot and cause the bleeding to resume.
Once the bleeding is controlled, secure a compression bandage or pad over the area, but do not remove the initial dressing until medical review. If the bleeding is heavy, soaks through the dressing, or fails to stop after 10 to 15 minutes of continuous pressure, seek emergency medical help immediately. Urgent medical attention is also necessary if the person feels faint, dizzy, or shows signs of significant blood loss.
Why Varicose Vein Bleeding is Serious
Bleeding from a varicose vein is serious due to the underlying anatomy and physics of the condition. Varicose veins are a manifestation of chronic venous insufficiency, meaning the veins are operating under abnormally high pressure because faulty valves allow blood to pool. Unlike a deeper vein, these superficial veins sit very close to the skin’s surface.
The skin overlying these significantly enlarged veins becomes thin and fragile (atrophic skin), making it highly susceptible to rupture from minor trauma like a scratch, shave, or bump. When the fragile skin and vein wall break under high pressure, the blood can spurt out rapidly. The rapid blood loss can be substantial, potentially leading to complications like anemia or circulatory collapse.
Another complication is the risk of infection, especially if the skin has already broken down into a venous ulcer before the rupture. The high venous pressure makes it difficult for the body to naturally stop the hemorrhage, and the bleeding can reoccur if the underlying vein problem is not treated. Individuals on blood thinners or who are elderly with more delicate skin face a higher risk of severe blood loss.
Strategies for Preventing Rupture
Preventing a varicose vein from rupturing involves a management plan focused on reducing pressure and protecting the skin. Wearing prescription-grade compression stockings is a primary preventative measure, as they apply graduated pressure to the legs. This assists blood flow back to the heart and counteracts the high venous pressure in the superficial veins.
Protecting the fragile skin over the veins from injury is important, which includes avoiding scratching or rubbing the area. Maintaining skin health is also important; keeping the skin moisturized helps maintain its barrier function, though care must be taken during application.
Lifestyle adjustments further reduce the risk by improving overall circulation. Regular exercise, particularly walking, helps the calf muscles pump blood more effectively. Avoiding long periods of sitting or standing and elevating the legs periodically throughout the day also helps to reduce blood pooling and pressure within the veins.
Definitive Treatment Options
Since bleeding indicates advanced venous disease, definitive medical treatment is necessary to eliminate the source of high pressure and prevent future ruptures. These procedures are often minimally invasive and are performed by a vascular specialist. A duplex ultrasound is typically used first to map the underlying vein damage.
Endovenous Ablation (RFA or EVLA) uses targeted heat delivered by a thin catheter inside the vein to seal it shut. Once the problematic vein is closed, blood naturally reroutes to healthier veins, immediately eliminating the high-pressure source.
Sclerotherapy involves injecting a liquid or foam solution directly into the varicose vein, causing irritation that makes the vein wall collapse and seal closed. For smaller, more superficial veins, this can be a highly effective method. Other techniques include VenaSeal, which uses a medical adhesive to close the vein, and microphlebectomy, which removes large, bulging veins through tiny incisions.