Have seen back to back patients this morning with severe venous insufficiency involving the left great saphenous vein. Both patients had history of multiple episodes of significant external hemorrhage. Neither had external signs of varicose veins but both had what appeared to be large spider veins (called telangiectasias) in the pretibial region (front of the lower leg). Bleeding is a more frequent presentation of venous insufficiency than is commonly thought. If you have veins that have bled externally or look like they are ready to bleed, seek us out. Let us perform a thorough venous insufficiency evaluation.