Haemorrhage from varicose veins and varicose ulceration: A systematic review

Abstract

Varicose veins (VVs) and varicose ulceration (VU) are usually considered non-life-threatening conditions, but in some cases they can lead to major complications such as fatal bleeding. The aim of this systematic review is to evidence the most updated information on bleeding from VV and VU. As evidence acquisition, we planned to include all the studies dealing with "Haemorrhage/Bleeding" and "VVs/VU". We excluded all the studies, which did not properly fit our research question, and with insufficient data. As evidence synthesis, of the 172 records found, after removing of duplicates, and after records excluded in title and abstract, 85 matched our inclusion criteria. After reading the full-text articles, we decided to exclude 68 articles because of the following reasons: (1) not responding properly to our research questions; (2) insufficient data; the final set included 17 articles. From literature searching, we identify the following main issues to be discussed in the review: epidemiology and predisposing factors, pathophysiology and forensic aspects, first aid. It has been estimated that deaths for bleeding due to peripheral venous problems account up to 0.01% of autopsy cases. From a pathological point of view, venous bleeding may arise from either acute or chronic perforation of an enlarged vein segment through the weakened skin. From a forensic point of view, in cases of fatal haemorrhage the death scene can even simulate non-natural events, due to crime or suicide. In most cases, incorrect first aid led to fatal complications. Further investigation on epidemiology and prevention measures are needed.

Fatal hemorrhage from peripheral varicose vein rupture

“…The time-lapse of death is between 5 and 20 minutes; despite the elevation of the affected limb and compression of the bleeding point seem easy maneuvers to save life. 21 The risk of life-threatening rupture of peripheral varicosities is increased in the affected subjects that are socially vulnerable or in conditions of social isolation. This typically occurs in the elderly, who constitute the most exposed and vulnerable patients, because of their skin and soft tissue fragility.…”

A rare suicide case involving fatal bleeding from varicose veins

“…The complications of varicose veins may range from mild complications such as lower extremity edema, skin pigmentation, dermatitis, skin ulcers, or lipodermatosclerosis, to more severe ones like venous ulcers (acute or chronic) or fat necrosis. Fragile walls are also responsible for spontaneous bleeding or trauma‐related bleeding [ 9 , 10 ].…”

Evaluation of static ulcer on lower extremities using wireless wearable near-infrared spectroscopy device: Effect of deep venous thrombosis on TRiggered Angiography Non-Contrast-Enhanced sequence magnetic resonance imaging

“…protein C deficiency, protein S deficiency, and antiphospholipid syndrome); thus, oral anticoagulation is potentially helpful for these patients. 23–28…”

“…protein C deficiency, protein S deficiency, and antiphospholipid syndrome); thus, oral anticoagulation is potentially helpful for these patients. [23][24][25][26][27][28] Conventional venography has been considered the gold standard for detecting DVT in patients with leg venous disease; however, the method is invasive, timeconsuming, and requires the use of radiation plus contrast media. Computed tomography (CT) venography is useful for excluding pulmonary embolism in patients with signs of thrombosis in the legs, but it cannot replace ultrasound as the first-line imaging modality for detecting DVT.…”