Treatment of small bleeding varicose veins with injection sclerotherapy. Bleeding blue blebs.

BACKGROUND: Bleeding is a well-recognized but seemingly uncommon complication of varicose vein disease. Some deaths have occurred in which bleeding developed from vessels in the base of chronic venous ulcers.

OBJECTIVE: To elucidate a more common type of venous bleeding that can be identified and treated by an experienced sclerotherapist.

METHODS: The records of a group of patients with bleeding superficial phlebectasias, primarily on the feet and ankles, are reviewed. All patients received injection sclerotherapy after the initial bleeding episode. A comparison was made between those patients whose bleeding points were sutured in the emergency department and those who were treated only with compression.

RESULTS: Suture-ligation of the bleeding site delayed healing when compared with simple compression. Concomitant injection sclerotherapy proved to be a successful and permanent method of treating these veins. No recurrent bleeding developed in any of the patients, even in those with previous episodes of bleeding.

CONCLUSIONS: Initial treatment of the bleeding blue bleb requires only compression of the tiny open vessel. Later injection sclerotherapy provides a permanent method of obliterating the thin-walled veins and prevents future bleeding. It is essential to treat the entire incompetent venous system as well as the bleeding site itself.