Sudden death by rupture of a varicose vein: Case report and review of literature

Abstract

Venous disease, including varicose veins and chronic venous insufficiency, is one of the most common chronic medical conditions. Haemorrhage from rupture of varicose veins in the legs is rare and can lead to sudden death. Nevertheless, this condition is not included among the causes of sudden death. In this case, an 88-year-old man was found dead in a large pool of blood at home. Initially, investigators mistakenly assumed that it was a case of homicide. Bloodstain pattern analysis was performed. An external examination of the victim showed an ulcer on the left foot and evident varicose veins untreated on the lower limbs. The aim of this study is to emphasize the role of treatment of varicose veins in the prevention of adverse events such as sudden death from acute haemorrhage.

Haemorrhage from varicose veins and varicose ulceration: A systematic review

“…Victims are in general elderly people, usually in their sixth to ninth decades of life, especially if they live isolated, in fact the victims are often found in their homes where they had been alone at the time of death. Although venous problems of the legs are more common in females, there is no correlation of the bleeding event with gender or laterality of the lesions . Concomitant medical conditions, such as arthritis or weakness from cerebrovascular disease may also predispose to this kind of problem, as these conditions may affect mobility and reactivity of patients .…”

“…The localization of a VV above a bone prominence (e.g. the medial malleolar site) may represent a mechanical factor for vein lesion . The sclerotic alterations of the vein wall of patients with CVI may also enhance the susceptibility of these vessels .…”

“…In fact, atrophy of the overlying skin, which can be encountered from clinical stage C4, predisposes to skin breakage that concomitantly with ischemic necrosis of the vein wall due also to venous hypertension in CVD produces also a tear in the vein wall with consequent bleeding In fatal cases, the bleeding may be so marked, due to the underlying venous ipertension condition in patients with advanced CVD, that can be even mistaken for arterial hemorrage and leads rapidly to a loss of consciousness and subsequent death, usually in a time lapse between 5 and 20 minutes …”

“…In fatal cases, the bleeding may be so marked, due to the underlying venous ipertension condition in patients with advanced CVD, that can be even mistaken for arterial hemorrage and leads rapidly to a loss of consciousness and subsequent death, usually in a time lapse between 5 and 20 minutes …”

“…But, if we consider an haemorrage event occurring on a ruptured VV, the bleeding may me massive and the patient could die in less than 20 minutes. This is due to the sclerotic changes and the skin changes occurring respectively in vein wall and skin and subcutaneous tissue that characterize CVD . The early skin changes (light pigmentation and eczema) occurring in C4a clinical stage, under the venous hypertension, may be responsible of the formation of a small chronic ulcer (<5 mm), connected with a slcerotic varicose superficial vein that can spontaneously rupture and initiate bleeding.…”