Annals of Vascular Surgery - Brief Reports and Innovations (Dec 2023)
Pulsatile varicose veins of the lower extremities with ulcer bleeding: Report of a case successfully managed by high ligation, radiofrequency alation and foam sclerotherapy
Abstract
Background: Pulsatile varicose veins of the lower extremities are rare in clinical practice. The indications and therapy for pulsating varicose veins remain unclear, and most cases are managed conservatively, with fewer reports of endovenous approaches. However, the treatment of pulsating varicose veins combined with ulcer bleeding remains unclear in the relevant literature. Case presentation: We report a case of sudden rupture and bleeding from a pulsatile varicose vein with a lower extremity ulcer. The patient was a 74-year-old male with atrial fibrillation, pulmonary hypertension, and tricuspid regurgitation. Emergency compression was first applied to stop the bleeding. Wound cleansing, antimicrobial treatment and bacterial control were performed. Elastic compression stockings (23–32 mmHg) were also prescribed. After a comprehensive duplex ultrasound examination and heart disease evaluation, high ligation of the great saphenous vein, radiofrequency ablation and foam sclerotherapy were performed. After the procedure, the chronic venous insufficiency symptoms improved significantly at the 1-month follow-up, and the ulcer was completely healed by postoperative month 5. The patient had mild lower limb swelling, and no ulcer recurrence was reported during the 18-month follow-up. Duplex scans at the 3- and 18-month follow-ups showed complete obliteration of the treated great saphenous vein. Conclusions: Pulsatile varicose veins with ulcer bleeding are a rare pathological condition. It usually results from reflux from the heart and may also be a consequence of hydraulic transmission dysfunction. We believe that comprehensive duplex ultrasound examination of the peripheral vascular system and complex surgical treatment allow the correction of superficial venous reflux and achieve favorable early and mid-term outcomes.
