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PAPERS: Andrew Bradbury, Christine Evans, Paul Allan, Amanda Lee, C Vaughan Ruckley, and F G R Fowkes What are the symptoms of varicose veins? Edinburgh vein study cross sectional population survey BMJ 1999; 318: 353-356 [Abstract] [Full text]

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Venous symptoms are improved by venous treatment

Robert A Weiss   (11 February 1999)

Bleeding from varicose veins

J P Wyatt   (9 March 1999)

Venous symptoms are improved by venous treatment 11 February 1999
Robert A Weiss, Assistant Professor Johns Hopkins University School of Medicine Send response to journal: Re: Venous symptoms are improved by venous treatment	Dear Sirs, I read your article with great interest. We have been fascinated with symptoms of varicose and spider veins and their relief for 15 years. I refer to our article, J Dermatol Surg Oncol 1990 Apr;16(4):333-6, Resolution of pain associated with varicose and telangiectatic leg veins after compression sclerotherapy, in which 85% of patients experienced relief of symptoms following eradication of reticular varicose networks by sclerotherapy. It is my firm belief that the Bradbury et al article correctly identifies venous symptoms but then assumes the non-beneficial effect of therapy based on absolutely no treatment data. It is a self-serving conclusion in a medical system in which there is insufficient funding and a tremendous backlog for treatment of varicose veins. Our findings treating over 14,000 patients over the last 15 years indicate that the symptoms of burning, fatigue, aching, pruritis, throbbing and nighttime cramping are significantly relieved approximatelty 85% of the time with eradication of the varicose tributaries and extensive spider veins. The myriad of patients with relieved leg symptoms continue to refer new patients with similar symptoms so that treatment requests continue at an exponential rate. Surely these patients will be unperturbed by this report indicating that their symptoms should not have responded to treatment. They remain unconvinced that their symptoms were not reliably related to the veins whose elimination corresponded to simultaneous symptom eradication. Robert A. Weiss, MD, Margaret A. Weiss MD Baltimore, MD, USA
Bleeding from varicose veins 9 March 1999
J P Wyatt Send response to journal: Re: Bleeding from varicose veins	Sir We read with interest the paper by Bradbury et al investigating the symptoms of varicose veins1, but were surprised that there was no mention of the problem of external haemorrhage. Bleeding from varicose veins may be spontaneous or follow minor trauma and may be significant2-4. In a study co-ordinated by the Scottish Trauma Audit Group of traumatic deaths in 1995 in the city of Glasgow, there were three deaths resulting from haemorrhage from varicose veins. The three individuals were elderly (aged 71 - 80 years), lived alone and were found dead at home, having exsanguinated from a varicose vein on the lower leg. One of the three knocked her leg against furniture, called an ambulance, but was found by the ambulance crew in cardiac arrest amid copious haemorrhage. The other two individuals were found dead having bled externally from a varicose vein - in one case, blood was found on the edge of a kitchen unit, implying that the vein may have been knocked against it; in the other case, no blood was found on any furniture - the haemorrhage may have been spontaneous. The risk of serious haemorrhage needs to be taken into consideration by those treating patients with varicose veins. Deaths following spontaneous haemorrhage or minor trauma to varicose veins are potentially preventable using simple first aid measures. Patients should be routinely advised that if bleeding occurs, they should apply direct pressure to the bleeding point, call for help, then continue to apply pressure until that help arrives. This advice needs to be particularly targeted to elderly individuals who may tolerate haemorrhage poorly and therefore appear to be at particular risk2,3. 1 Bradbury A, Evans C, Allan P, Lee A, Ruckley CV, Fowkes FGR. What are the symptoms of varicose veins? Edinburgh vein cross sectional population survey. BMJ 1999;318:353-6. 2 Morrow PL, Hardin NJ, Karn CM, Beloin R, McDowell RW. Fatal hemorrhage caused by varicose veins. Am J Forensic Med Pathol 1994; 15: 100-4. 3 Evans GA, Seal RME, Evans DND, Craven JL. Spontaneous fatal haemorrhage caused by varicose veins. Lancet 1973; 1: 1359-60. 4 Wigle RL, Anderson GV. Exsanguinating hemorrhage from peripheral varicosities. Ann Emerg Med 1988; 17: 135-7. JP Wyatt Consultant Accident and Emergency Treliske Hospital Truro Cornwall TR1 3LJ PT Grant Director Scottish Trauma Audit Group Accident and Emergency Western Infirmary Glasgow P Vanezis Professor Forensic Medicine Unit Glasgow University