Varicose veins are a common health problem that affects more than half of the population[1]. While they’re unsightly and often uncomfortable, they’re generally regarded as harmless. However, if left untreated, varicose veins can cause numerous health complications, some of which can be quite serious, resulting in irreparable harm, or even death. If you have varicose veins, being aware of the potential health risks they pose and staying on top of your vein health with proper monitoring and treatment can help you prevent or manage complications at their earliest stages.
Bleeding veins
Varicose veins are prone to rupture because their impaired structure weakens them and the elevated blood pressure caused by venous insufficiency adds additional stress. Though varicose veins occur more frequently in women, both men and women are equally at risk for bleeding varicose veins[2].
When varicose veins rupture it typically happens in one of two ways:
- Pressure from the enlarged vein causes the fragile overlying skin to break down, exposing the vein, which leads to rupture [3]. Once the skin is broken an open wound known as a venous ulcer develops[3]. Following this, the skin around the ruptured vein becomes hardened and develops a dark coloration due to leakage and breakdown of blood cells[3].
- An existing venous ulcer worsens, eroding a surrounding varicose vein, causing it to rupture[2].
Ruptured varicose veins can be life threatening, particularly for the elderly or anyone who suffers from dementia, is socially isolated, has restricted mobility, or has suffered a recent trauma[3]. Varicose vein patients who have cardiovascular disease and use blood thinners are at increased risk for severe blood loss when varicose veins rupture[2]. A varicose vein that is located over a bony area such as a knee or ankle bone may also be more prone to rupturing and bleeding[2]. Additionally, excess alcohol consumption dilates blood vessels and can complicate bleeding varicose veins by increasing the speed of blood loss[2].
Deep vein thrombosis
Deep vein thrombosis (DVT) is a serious complication of varicose veins in which sluggish, turbulent blood flow triggers the formation of a blood clot. Symptoms of DVT include swelling, warmth, or pain in the affected leg.
The risk for DVT is slightly higher among men than women[4]. Risk is also higher in the elderly, increasing rapidly after age 45, and elderly patients with DVT are more likely to experience complications from DVT. Additionally, certain ethnic groups are more prone to developing DVT, with rates highest among African-Americans and lowest among Asians and Hispanics[4]. Other risk factors include being overweight or obese, undergoing surgery or being hospitalized, having trauma to the legs, pregnancy, use of oral contraceptives, using post-menopause hormone replacement therapy, and long trips involving lengthy airplane, train, or automobile transportation[4].
There are four major complications that arise from DVT:
- Post-Thrombotic Syndrome
- The most common complication of DVT is a condition known as post-thrombotic syndrome (PTS), which is thought to occur from increased venous blood pressure resulting from the DVT[5]. PTS occurs in up to 50% of DVT patients[6]. Symptoms of PTS are similar to those of venous insufficiency and include leg pain, swelling, redness, and sensations of heaviness and fatigue in the legs[5]. As with varicose vein symptoms, PTS symptoms can be constant or intermittent and tend to worsen with standing or walking and improve with rest and elevation of the legs.
- Pulmonary Embolism
- DVT can become fatal if a blood clot travels to the lungs, which is known as a pulmonary embolism. Pulmonary embolisms can be difficult to detect in the early stages and, as a result, the risk of death from pulmonary embolism is significant, ranging from 10% to 30%[4].
- Recurrence
- DVT can develop into a chronic, recurring condition, with recurrence rates of 5% to 7% per year[4]. The risk of recurrence is higher in those who are elderly or obese and men are reportedly 60% more likely to experience recurrence than women[4]. The risk of recurrence also increases if the original clot is higher up in the leg, if the original clot develops into a pulmonary embolism, or if any portion of the blood clot remains after treatment[4].
- Increased Bleeding
- Blood thinners are used to treat and manage DVT and this increases the risk of excessive bleeding.
Venous Ulcers
Venous hypertension causes fluid and blood cells to leak from the veins, which causes swelling, pressure, and inflammation in surrounding tissues and starves the skin of oxygen. Eventually, the skin breaks down, resulting in open wounds called venous ulcers. Advanced age increases risk, with 4% of U.S. adults over age 65 suffering from venous ulcers[7]. Other risk factors include a family history of varicose veins, being overweight or obese, being sedentary, or having multiple pregnancies[7].
Venous ulcers are slow and costly to heal, taking many months and costing thousands of dollars in additional medical expenses as well as lost workdays and productivity[7]. They can also develop skin cancer, adding to their danger and the need to prevent or heal them as quickly as possible.[7].
Lipodermatosclerosis
This painful condition occurs when the layer of fat directly below the skin becomes inflamed, causing swelling, redness, and hardening of the skin[8]. Women are at greater risk for developing lipodermatosclerosis (LDS) than men and it is thought that estrogen plays a role[9]. Obesity is also a major risk factor for LDS with about 2/3 of instances occurring in obese patients[9].
As LDS progresses the skin around the ankles contracts and tightens causing the leg to develop a characteristic appearance described as that of an inverted champagne bottle. Venous ulcers may also develop in LDS due to the hardening and weakening of the skin. Additionally, small blanched areas of scar tissue may arise on the lower leg or foot due to poor blood supply and slow healing[8].
In the initial stages, a type of blood thinner that breaks down the clotting protein fibrin may be prescribed[10]. Steroids may also be recommended[10]. Chronic LDS is usually managed conservatively with compression stockings or compression wraps[10].
There are simple procedures that can resolve your varicose vein problems and significantly decrease your risk of developing these and other hazardous health complications. To learn about these treatments, we invite you to schedule a free consultation at Empire Vein Specialists.
DVVI is the top provider of VenaSeal®, the leading outpatient varicose vein treatment, in the USA. All of our physicians are board-certified vascular surgeons who specialize in helping people like you.
To schedule a free consultation, please call 1-800-VARICOSE (1-800-827-4267) today.
References
- What to Know About Varicose Veins. Available from:
https://health.usnews.com/health-care/patient-advice/articles/what-to-know-about-varicose-veins. - Haemorrhage from varicose veins and varicose ulceration: A systematic review – Serra – 2018 – International Wound Journal – Wiley Online Library. 2022
https://onlinelibrary.wiley.com/doi/10.1111/iwj.12934 - Unusual death due to a bleeding from a varicose vein: a case report. BMC Research Notes, 2012. 5(1): p. 1-3
https://link.springer.com/article/10.1186/1756-0500-5-488 - Epidemiology and risk factors for venous thrombosis. Seminars in hematology, 2007. 44(2)
https://www.ncbi.nlm.nih.gov/pubmed/17433897 - The post-thrombotic syndrome. Hematology. American Society of Hematology. Education Program, 2016. 2016(1)
https://www.ncbi.nlm.nih.gov/pubmed/27913509 - (PDF) The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper. 2022
https://www.researchgate.net/publication/358831551_The_Post-thrombotic_Syndrome-Prevention_and_Treatment_VAS-European_Independent_Foundation_in_AngiologyVascular_Medicine_Position_Paper - Venous Ulcers: Diagnosis and Treatment. American Family Physician, 2022. 100(5): p. 298-305
https://www.aafp.org/afp/2019/0901/p298.pdf - Lipodermatosclerosis | Genetic and Rare Diseases Information Center (GARD) an NCATS Program. 2022; Available from: https://www.ncbi.nlm.nih.gov/pubmed/.
- Lipodermatosclerosis. Dermatologic therapy, 2010. 23(4)
https://www.ncbi.nlm.nih.gov/pubmed/20666825 - Atrophie blanche | DermNet NZ. 2022; Available from:
https://dermnetnz.org/topics/atrophie-blanche.