Protocol-based Treatment of Spontaneous Hemorrhage from Varicose Veins Prevents Short- and Long-term Recurrence of Bleeding

Tuesday, September 19, 2023

3:20 PM – 3:30 PM US EDT

Location: Grand Ballroom A

Introduction, Objectives, and/or Purpose: Spontaneous hemorrhage from erosion of varicose veins through the skin is a serious and occasionally fatal complication of varicose vein disease. Various treatments, both acute and delayed, have been advocated. Our two-step clinical protocol was designed to prevent further hemorrhage without delay, and then to provide durable freedom from recurrent bleeding.

Methods: All patients referred to our surgical vein practice with hemorrhage from varicose veins were entered into a prospective registry. On presentation, all patients underwent diagnostic duplex ultrasound for venous reflux. Immediate treatment was with ultrasound-guided polidocanol/CO₂ foam sclerotherapy of the bleeding varicosity and adjacent veins. Subsequent endovenous ablation of underlying, incompetent axial veins, with concurrent microphlebectomy when indicated, was scheduled and performed within 60 days.

Results: Fifty-nine patients were referred with recent hemorrhage from varicose veins over a period of four years. Underlying incompetence of axial (great, small, or anterior saphenous) was found in 54 (92%). Prompt sclerotherapy was performed in 52 out of the 59 patients — for clinical reasons or patient preference, 7 had endovenous ablation as their only treatment. Of the 54 with truncal vein incompetence, 48 had ablation — five declined, and one was too frail for any further intervention. During a mean follow-up of 2.2 years, only 4 (7%) patients had recurrent hemorrhage: one had failed to return for their scheduled ablation and two were on chronic anticoagulation. All four were re-treated without further recurrence..

Conclusion(s): A two-step protocol of immediate ultrasound-guided foam sclerotherapy, followed within eight weeks by endovenous ablation of incompetent axial veins and concurrent microphlebectomy, allowed efficient, patient-centered treatment and provided durable freedom from subsequent hemorrhage.

Presenting Author(s)

Richard W. Bock, MD

Vascular Surgeon
Asheville Vein Center
Asheville, North Carolina, United States

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.

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Co-Author(s)

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Danielle T. Fontenot, MD, MS, RPVI

Vascular Surgeon
Asheville Vein Center
Asheville, North Carolina, United States

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
Spencer Bock, Bachelor of Arts, University of Virginia

Postgraduate Researcher
Asheville Vein Center
Asheville, North Carolina, United States

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
Gwyn E. Eiler, BS, RVT

Registered Vascular Technologist
Asheville Vein Center
Weaverville, North Carolina, United States

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
Kristie L. Worley-Fry, AVLS and MGMA member

Office Manager
Asheville Vein Center
Candler, North Carolina, United States

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
John Blebea, MD, MBA

Clinical Professor of Surgery
Central Michigan University
Central Michigan University
Saginaw, MI, United States

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose. or AVLS has reviewed / mitigated there are no relevant financial relationships with ineligible companies.