A Burst Vein Can Spell Major Blood Loss

“With a burst vein what should I do? Can’t people bleed to death? Shouldn’t I be worried?”

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All good questions. Especially if you have seen this happen.

And yes there have been people who have bled to death.

There is the story of the elderly woman whose remains were found with her dogs days after she expired from bleeding leg varicosities.

Spontaneous Bleeding

Spontaneous bleeding can occur from a burst vein in other areas of the body.

You might have seen somebody with a bright red area spread across a large area of the white of their eye. You might even have experienced this yourself.

Burst vein in white of eye - a conjunctival haemorrhage

Spontaneously burst vein in white of eye

It often feels uncomfortable. There has been some swelling in the space between the eye surface and the firm globe.

It looks dramatic.

But usually there is no concern. The pressure from the tissue planes on either side control the relatively low pressure within normal veins.

It’s worth checking the person’s blood pressure. It might be an indication it is raised. Usually though it is normal.

Quite a few people experience a spontaneous vein rupture in other areas of their body. Often signalled by a quite painful pinging sensation felt most in fingers.

The result appears like bruise.  

At times local trauma to the finger can be related. Like pinching it against a metal or other unforgiving surface.

Spontaneous Burst Vein In Leg

Just as with fingers a similar spontaneous burst vein can occur with varicose veins.

If it is under the skin structure then a bruise might be the only consequence.

Burst vein on side of leg with resultant bruise

Bruising left after spontaneous vein bleed

With your leg being a larger structure you might not experience any sensation at the time.

If you break the surface of your skin with a graze or a cut, as long as you do not slash through an artery, the bleeding stops pretty quickly. Usually you apply some pressure with a gauze or cloth.

As healthy veins have a very low pressure within them gentle compression closes them easily. The blood clots at the wound edge sealing it.

Injury To Varicose Vein

However a graze or cut over a varicose vein can produce large volumes of blood relatively rapidly. Unlike an artery it will not pulse or spurt over a large distance.

Large knotty varicose veins that could result in high flow bleeding from a burst vein with an injury

Large varicosities that could bleed significantly with an injury

But the stream can have quite a bit of pressure behind it. The larger the varicose vein injured the wider the hose of flow will be.

Pressure will depend on how far up your leg that varicose vein defect extends.

If the injury is at ankle level and there is continuous varicose damage right to the groin there could be 70cm of water pressure behind it. When you are standing.

That’s around 50mm mercury. A little under a standard diastolic arterial pressure!

Put the leg horizontal and you immediately convert that pressure to nearer zero.

Therefore elevation of the bleeding limb will immediately decrease the flow significantly.

Combine that with local compression and the burst vein torrent is easily stemmed.

Varicose veins with a normal depth of skin above them will require significant trauma to break that barrier.

"Blue Blebs"

But over time segments can stretch or erode the overlying skin to the point it is paper thin. What we call a “blue bleb” shows.

The blueness is quite intense as there is so little tissue between the skin surface and the blood in the vein.

Burst vein occurs more readily with shallowly located blue bleb

Blue blebs on shin

These very shallowly located parts of varicose vein can break without a palpable injury. Presumably there is some minor graze or rubbing that breaks that final barrier down.

Because little is felt these are the ones that can bleed for some time before you become aware of them.

In some cases people have got out of the shower, no doubt dried themselves, and left a trail of blood from an unnoticed burst vein.