My initial response to this question was going to be “one” but after reconsidering I believe the answer should be “none”. Many patients who I have seen for external bleeding from varicose or spider veins had veins which I would consider to be “ripe” for bleeding for many months or years prior to their first bleed. One must take a defensive approach here and be able to identify which veins are likely to have bleeding complications prior to the actual bleeding episode. Professional vein evaluations and treatments to should be offered earlier in the disease process and minimally invasive treatments performed as appropriate. The record for maximum number of bleeding episodes prior to seeking my assistance is 14. The final episode resulted in an ulcer and after endovenous ablation of the great saphenous vein the ulcer healed within 2 weeks and the patient has not bled since, now more than 2 years.