Bleeding from Varicose Veins as a Complication of Chronic Venous Insufficiency: Risk Factors and Modern Treatment Approaches

Abstract

Introduction. A severe complication of chronic venous diseases of the lower extremities is bleeding, with an incidence rate ranging from 3% to 9.1%. Due to the limited number of informational reports, the optimal treatment strategy for this category of patients remains a topic of debate. Objective. To analyze the risk factors for bleeding from varicose veins and develop a treatment strategy. Materials and Methods.From 2020 to 2024, a prospective two-stage study was conducted. The first stage involved collecting and analyzing data from patients with chronic venous disease (CVD) to determine the incidence of venous bleeding and identify potential risk factors. The aim of the second stage was to assess the effectiveness of the proposed treatment strategy: foam sclerotherapy to stop active bleeding, followed by the elimination of saphenous reflux using radiofrequency ablation. Effectiveness Criteria: The frequency of bleeding recurrence, anatomical success of vein obliteration, regression of clinical symptoms, and improvement in quality-of-life parameters. Results and Discussion: Among the total number of patients with CVD of the lower extremities, 3.1% were hospitalized due to bleeding from varicose veins. Of these, 69.2% sought medical attention for the first episode of bleeding, while 23.1% presented with recurrent bleeding. The mean age was 57.3 ± 7.8 years, and the average body mass index was 29.8 ± 5.45 kg/m². Patients were classified into the following clinical stages: C4a – 7.7%, C4b – 15.4%, C4c – 23.1%, C5 – 15.4%, and C6 – 38.5%. The comorbidity profile of the studied patients included hypertension in 46.2%, type 2 diabetes mellitus and ischemic heart disease in 23.1%, heart failure in 15.4%, and a history of pulmonary embolism with pulmonary hypertension in 15.4%. Additionally, 46.2% of patients were taking antiplatelet agents, and 23.1% were on anticoagulants. The average volume of foam used for urgent sclerotherapy was 1.5 ± 0.7 mL. Radiofrequency ablation was supplemented with foam sclerotherapy using a 3% polidocanol solution to obliterate the altered trunk of the great saphenous vein in the lower third of the leg and incompetent posterior tibial perforating veins. Postoperative ultrasound examination confirmed 100% occlusion of the treated vein segments. Among the recorded adverse events, induration with hyperpigmentation was observed in 53.8% of patients, and ecchymosis in 38.5%. One month after treatment, there was a regression of clinical symptoms as measured by the revised Venous Clinical Severity Score (r-VCSS), decreasing from 16.4 ± 4.3 points before treatment to 13.7 ± 4.8 points. However, a statistically significant difference (p=0.02) was observed only after six months. The proposed treat- ment strategy significantly improved quality-of-life scores as early as one month post-treatment, with an increase from 23.1 ± 4.3 points to 17.5 ± 5.9 points (P<0.001), showing continued positive dynamics throughout the observation period. Conclusions. Bleeding from varicose veins, as a complication of chronic venous disease, occurs in 3.1% of patients. The most significant risk factors for bleeding are clinical- anatomical features, comorbidities, and medication use. An effective treatment strategy for patients with varicose vein bleeding – confirmed by the positive dynamics of r-VCSS and AVVQ-UA scores and the absence of recurrent bleeding – is urgent foam sclerotherapy to stop active bleeding, followed by radiofrequency ablation of the axial reflux.