Bleeding from the Ulcer of the Lower Leg Due to Varicose Vein Treated by Foam Sclerptherapy: Report of a Case

Abstract

We report here a rare case of bleeding from the ulcer of the lower leg due to varicose vein. Case: Forty eight-year-old Indonesian male (at the time of initial diagnosis). He visited our hospital complaining of bleeding from the lower left leg. Skin ulcer 15×20 mm in diameter was recognized in front of the lower leg. Fortunately the bleeding was clotted. Ultrasonography revealed reflux of the left great saphenous vein by manual compression of the calf and the diameter was 10 mm. He strongly desired treatment with as little medical expenses as possible for reasons such as not joining health insurance. Foam sclerotherapy was performed prepared with 6 mL of air using 3% polydocanol (ethoxyscrerol) 2 mL by the Tessari method. Pressure continuation by elastic bandage was indicated until the next examination day. After 2, 4, and 7 days, the bandage was removed in the outpatient room, and treatment was added as before using 1% polydocanol at insufficient occlusion sites. It was confirmed by the ultrasonography that the varicose vein was almost diminished after 9 days. The ulcer healed 39 days after the first treatment. It was explained that there was a concern of the recurrence. He was advised to wear the elastic stockings. Five years after the initial diagnosis (53 years old), he visited our hospital. There was no recurrence of varicose veins and ulcers except for only mild pigmentation. Ultrasound confirmed the shrinkage of the great saphenous vein.