Class 9 Diseases of the circulatory system

I70-I79 Diseases of arteries, arterioles and capillaries

I70 Atherosclerosis

• I70.0 Atherosclerosis of the aorta
• I70.1 Atherosclerosis of the renal artery
• I70.2 Atherosclerosis of the arteries of the extremities
• I70.8 Atherosclerosis of other arteries
• I70.9 Generalized and unspecified atherosclerosis

I71 Aneurysm and aortic dissection

• I71.0 Aortic dissection of any part
• I71.1 Aneurysm of the thoracic aorta, ruptured
• I71.2 Thoracic aortic aneurysm without mention of rupture
• I71.3 Abdominal aortic aneurysm, ruptured
• I71.4 Abdominal aortic aneurysm without mention of rupture
• I71.5 Aneurysm of the thoracic and abdominal aorta, ruptured
• I71.6 Aneurysm of the thoracic and abdominal aorta without mention of rupture
• I71.8 Aortic aneurysm of unspecified localization, ruptured
• I71.9 Aortic aneurysm of unspecified location without mention of rupture

I72 Other forms of aneurysm

• I72.0 Carotid artery aneurysm
• I72.1 Aneurysm of the artery of the upper extremities
• I72.2 Renal artery aneurysm
• I72.3 Iliac artery aneurysm
• I72.4 Aneurysm of the artery of the lower extremities
• I72.8 Aneurysm of other specified arteries
• I72.9 Aneurysm of unspecified location

I73 Other peripheral vascular diseases

• I73.0 Raynaud's syndrome
• I73.1 Thromboangitis obliterans [Berger's disease]
• I73.8 Other specified peripheral vascular diseases
• I73.9 Peripheral vascular disease, unspecified

I74 Embolism and thrombosis of arteries

• I74.0 Embolism and thrombosis of the abdominal aorta
• I74.1 Embolism and thrombosis of other and unspecified parts of the aorta
• I74.2 Embolism and thrombosis of the arteries of the upper extremities
• I74.3 Embolism and thrombosis of the arteries of the lower extremities
• I74.4 Embolism and thrombosis of arteries of the extremities, unspecified
• I74.5 Embolism and thrombosis of the iliac artery
• I74.8 Embolism and thrombosis of other arteries
• I74.9 Embolism and thrombosis of unspecified arteries

I77 Other lesions of arteries and arterioles

• I77.0 Acquired arteriovenous fistula
• I77.1 Narrowing of the arteries
• I77.2 Artery rupture
• I77.3 Muscular and connective tissue dysplasia of arteries
• I77.4 Compression syndrome of the celiac trunk of the abdominal aorta
• I77.5 Arterial necrosis
• I77.6 Arteritis, unspecified
• I77.8 Other specified changes in arteries and arterioles
• I77.9 Changes in arteries and arterioles, unspecified

I78 Diseases of capillaries

• I78.0 Hereditary hemorrhagic telangiectasia
• I78.1 Non-tumor nevus
• I78.8 Other capillary diseases
• I78.9 Capillary disease, unspecified

I79* Lesions of arteries, arterioles and capillaries in diseases classified elsewhere

• I79.0* Aortic aneurysm in diseases classified elsewhere
• I79.1* Aortitis in diseases classified elsewhere
• I79.2* Peripheral angiopathy in diseases classified elsewhere
• I79.8* Other lesions of arteries, arterioles and capillaries in diseases classified elsewhere

Atherosclerosis of cerebral vessels (ICD-10 code: I67.2)

The second choice zones are the projection zones of the carotid arteries and vertebrobasilar arteries.

Rice. 84. Irradiation zones in the treatment of cerebral atherosclerosis. Legend: pos. “1” — projection of the carotid vessels, pos. “2” - projection of the vertebrobasilar vessels.

The projection zones of influence on the carotid arteries (Fig. 84, position “1”) are positioned in the middle of the anterior surface of the neck, medial to the inner edge of the sternocleidomastoid muscle. When irradiating the carotid arteries, it should be remembered that the pressor (nozzle) effect on the left carotid sinus can cause a significant decrease in blood pressure. The impact on the vertebrobasilar arteries is carried out at the level of 2-4 cervical vertebrae, 2.5 cm outward from the spinous processes.

The greatest effectiveness in treating the disease is achieved when the localization of atherosclerotic plaques is known, established on the basis of instrumental studies. It is preferable to carry out duplex scanning of the arteries with marking of the most affected areas of the artery.

Additionally, irradiation of the projection zones of the aortic arch and pulmonary trunk, paravertebral zones C3-C7 is performed.

Irradiation zones in the treatment of atherosclerosis of the vessels of the head

Obliterating atherosclerosis of the lower extremities

According to the international classification of diseases (ICD 10), obliterating atherosclerosis of the lower extremities is a disease of the leg arteries, characterized by their occlusive-stenotic lesions caused by excessive accumulation of cholesterol and lipids on the walls of blood vessels. Such lipid and cholesterol accumulations, called atherosclerotic plaques in medicine, can significantly increase in size as the disease progresses and thereby provoke the appearance of not only a fairly pronounced narrowing (stenosis) of the lumens of the arteries, but also their complete closure, which in most cases leads to ischemia of the lower extremities.

In order to most fully present the mechanism of pathological changes in this disease, it is recommended to familiarize yourself with medical sources containing various illustrations on the topic, as well as photos of obliterating atherosclerosis of the lower extremities.

Prevalence of the disease

Obliterating atherosclerosis of the arteries of the lower extremities is considered the most common vascular disease. According to generalized data from various medical studies, with atherosclerosis, occlusive-stenotic lesions of the arteries of the legs are found in 20% of patients. It is noted that this disease most often occurs in people belonging to a more mature age category. According to statistics, between the ages of 45 and 55 years, this disease is detected in only 3-4% of people, while at older ages it is detected in 6-8% of the population. It is also important to note the fact that atherosclerotic diseases are most often diagnosed in the male half, and in particular, in those men who abuse tobacco smoking for a long period of time.

Causes of the disease

Medical specialists are inclined to believe that the main reason for the development of the disease in question lies in lipid metabolism disorders, namely in a significant increase in the level of lipophilic natural alcohol (cholesterol) in the blood. However, they also note that the accumulation of cholesterol in the vessels alone is not enough to cause atherosclerosis. In order for atherosclerosis obliterans to develop, in addition to an increase in cholesterol levels, some risk factors must also be present that can adversely affect the structure and protective properties of the artery. Such factors include:

• mature age (45 years and older);
• gender (male);
• smoking (nicotine initiates the appearance of persistent vascular spasms, which often contributes to the development of various pathological processes);
• various serious illnesses (diabetes mellitus, hypertension, etc.);
• unhealthy diet (excess animal fats);
• lack of physical activity;
• overweight;
• excessive psycho-emotional and physical stress;
• frostbite of the extremities, as well as frequent hypothermia;
• previous leg injuries.

Currently, representatives of medicine believe that in addition to all of the above conditional causes of atherosclerosis, there is also a risk factor for the development of atherosclerotic diseases such as genetic predisposition. It has been scientifically proven that in some cases, an excessive increase in cholesterol in a person’s blood may be due precisely to his genetic inheritance.

Classification and symptoms of the disease

Symptoms of obliterating atherosclerosis of the lower extremities and their severity usually directly depend on the nature of the disease itself and the stage of its development. determined both by the degree of blockage of the artery and the severity of the resulting disturbances in the blood supply in the legs.

Modern medicine identifies four main stages of development of this disease, each of which is expressed by a specific clinical picture. These include:

• Stage 1 (is the initial asymptomatic stage of the disease, diagnosed by taking a biochemical blood test, which reveals elevated lipid levels);
• stage 2 (expressed by the appearance of primary signs of the disease in the form of numbness, chilliness, muscle cramps and mild pain in the lower extremities);
• stage 3 (characterized by a fairly pronounced clinical picture, in which severe pain appears in the legs, lameness may be observed, and thinning of the skin and the formation of small bleeding wounds and ulcers are detected);
• Stage 4 (defined as the most severe and is expressed by the appearance of constant pain, muscle atrophy, total lameness, as well as the occurrence of gangrene and trophic ulcers). Medical specialists warn that obliterating atherosclerosis of the vessels of the lower extremities is a serious and dangerous disease, untimely treatment of which can lead to the appearance of gangrene of the leg with its subsequent loss. This means that if any of the above symptoms occur, it is important to immediately consult a doctor in order to promptly diagnose and treat the developed disease.

Diagnosis of the disease

The diagnosis of “obliterating atherosclerosis ICD 10 code 170” is made on the basis of the collected anamnesis, manifested clinical signs, as well as laboratory and instrumental research methods, including passing some tests (urine, blood) and undergoing a number of special medical examinations (rheovasography, Dopplerography, thermometry, arteriography and functional load tests).

Treatment of the disease

After carrying out all the necessary diagnostic procedures followed by making an accurate diagnosis, the doctor individually prescribes to the patient the most suitable treatment for obliterating atherosclerosis. When drawing up a treatment regimen for this disease, the doctor always takes into account the stage of its development, the severity of existing ischemic disorders and the presence or absence of any complications.

Relief of pathological processes in atherosclerotic diseases can include both a set of therapeutic and health measures aimed at adjusting everyday lifestyle, as well as conservative, endovascular or surgical methods of treatment.

Treatment and health measures in such cases include:

• to give up smoking;
• hypocholesterol diet food;
• elimination of existing diseases and pathologies that aggravate the course of atherosclerosis;
• dosed physical activity;
• prevention of hypothermia of the skin of the legs and feet, as well as their protection from injury.

Treatment of obliterating atherosclerosis of the lower extremities, carried out conservatively, involves the use of physiotherapy, the use of antibiotic ointments, as well as the use of various vasodilators, vitamins, antispasmodics and drugs that improve tissue nutrition and blood microcirculation.

Endovascular treatments include balloon dilatation, angioplasty and arterial stenting. In modern medicine, these treatment methods are considered to be fairly effective non-surgical methods of restoring blood circulation through the vessels.

Surgical treatment is carried out only when a number of severe complications arise against the background of severe ischemia that is resistant to medication. The main surgical methods for treating atherosclerosis of the legs are: prosthetics (replacement of the affected part of the vessel with a prosthesis), bypass surgery (restoration of blood flow using an artificial vessel), thromboendarterectomy (liquidation of the affected artery).

In cases where gangrene appears against the background of atherosclerotic disease, multiple necrosis of leg tissue is observed, and it is not possible to restore blood flow through surgery, amputation of the affected part of the leg is prescribed.

Progressive atherosclerosis is one of the main causes of disability caused by amputation of the lower extremities, and, therefore, for each patient suffering from this disease, it is important to begin in time to carry out all the necessary treatment procedures and strictly follow the basic medical instructions and recommendations.

ICD, or The International Classification of Diseases is a document, specially created for statistical recording and classification of various diseases. The World Health Organization regularly reviews and updates it, and today doctors use the tenth edition of the ICD.
Diseases in this document are divided into classes, classes into so-called diagnosis blocks, and those, in turn, into headings. Classes are formed based on the nature of the disease itself (infectious disease, nervous system disorder, circulatory disorder). The blocks specify the disorder (for example, in the class of infectious diseases there are blocks of bacterial, viral, fungal).

The headings include final diagnoses, taking into account not only the general nature of the disease, but also localization, mode of transmission, etc. All characteristics of the disease are coded using Latin letters and numbers. Letters indicate classes, numbers indicate blocks and headings.

So, for example, the diagnosis “atherosclerosis of the arteries of the extremities” has code I70.2, where the letter I denotes the class - diseases of the circulatory system, the numbers 70 - the block “atherosclerosis”, and 2 specifies the disease by location.

Atherosclerosis according to ICD-10

Atherosclerosis is a disease of the arteries, arising due to disturbances in protein and lipid metabolism in the body.

With this disease, cholesterol and lipoproteins accumulate on the walls of the arteries, forming dense plaques. Over time, connective tissue grows into these plaques, causing them to expand and harden.

At the same time, the lumen of the vessel decreases, blood flow is disrupted, and in the most severe cases, atherosclerotic plaques completely clog the artery, blocking blood access to organs and tissues.

ICD-10 distinguishes five types of atherosclerosis, and each has an additional digital index:

• I70.1 – atherosclerosis of the renal artery;
• I70.2 – arteries of the extremities;
• I70.8 – other arteries (mesenteric and peripheral);

In terms of symptoms, it is similar to atherosclerosis - it also causes the formation of blood clots and blockage of blood vessels (obliteration). The important difference is that atherosclerosis is caused by a disorder of fat metabolism, and endarteritis is an autoimmune disease. In addition, endarteritis can affect not only arteries, but also veins.
Let's take a closer look at the types of atherosclerosis of blood vessels and arteries.

ICD-10 I70.0 Aorta

The aorta is the largest blood vessel in the human body. This is why aortic atherosclerosis is especially difficult to recognize: it takes a lot of time for plaque to grow to a size that can interfere with blood flow in this vessel. This disease develops over many years, and it can only be recognized at the preclinical stage with the help of special laboratory tests.

At the clinical stage, symptoms such as:

1. cardiopalmus;
2. headache;
3. dyspnea;
4. dizziness;
5. fainting.

Attention! If left untreated, this disease can lead to myocardial infarction.

I70.1 Renal artery

This disease affects the renal artery, as a result of which the blood supply to the kidneys is disrupted, which, in turn, leads to a deterioration in their functions. This disease also develops over a long period of time, usually against the background of hypertension.

Symptoms include problems with urination, abdominal pain, and sometimes nausea and vomiting. At the preclinical stage, the development of the disease is indicated by a drop in potassium levels in the blood.

ICD-10 I70.2 Arteries of the extremities

When people talk about this disease, they usually mean damage to the arteries of the legs. Atherosclerosis of the arteries of the hands is much less common.

In both cases large blood vessels are affected, due to which blood flow in the extremities is disrupted, and tissues begin to experience oxygen starvation. Even if the blood flow is not completely blocked, the risk of developing gangrene is high.

Symptoms of the disease are numbness of the extremities, pale skin, convulsions, and in later stages – cyanosis and cyanosis.

Important: Vascular atherosclerosis should not be confused with endarteritis.

The symptoms are almost identical, but the course of the disease and treatment methods vary greatly. In addition, endarteritis almost never affects the upper extremities.

I70.8 Other species

By “others” in the ICD are meant the mesenteric arteries, which are responsible for the blood supply to the intestines and pancreas, the hepatic, gastric, splenic arteries, as well as two carotid arteries - the external and internal, which are responsible for the blood supply to the head. That is, the ICD-10 code for cerebral atherosclerosis will also be I70.8.

The defeat of the latter is the most dangerous - a violation of the blood supply to the brain leads to deterioration of memory, cognitive functions and even blindness, and with poor treatment - to a stroke. Moreover, unlike other types, The causes of atherosclerosis of the carotid arteries are still unclear. According to one hypothesis, this disease is autoimmune in nature.

I70.9 Generalized and unspecified atherosclerosis

This diagnosis is made if the disease affects several vessels at the same time, or if it is not possible to accurately determine the source of its occurrence.

The following additional codes are used to indicate the presence or absence of gangrene, for optional use with the corresponding subcategories in I70.

• 0 without gangrene
• 1 For gangrene

Excludes: atherosclerosis of renal arterioles (I12.-)

Sclerosis (medial) of Mönckeberg

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Obliterating atherosclerosis of the vessels of the lower extremities (ICD code 10): treatment and prevention

If blood flow through the arteries of the legs is disrupted, accompanied by a narrowing of their lumen and partial absence of vascular patency in the femoral and popliteal areas, obliterating atherosclerosis of the vessels of the lower extremities is diagnosed, having an ICD10 code: 170.2.

Blockage of the lumen of blood vessels occurs as a response to the accumulation of a large number of lipid and cholesterol formations. These plaques, initially small, gradually increase in size and grow in the lumen of the artery. Stenosis of the arteries occurs, and then they are completely closed.

ICD 10 classifies obliterating atherosclerosis of the vessels of the lower extremities as a pathology associated with an overwhelming excess of cholesterol on the walls of the arteries. This disease is common in 20% of elderly patients with atherosclerosis.

But it has been noted that in people of pre-retirement age, the number of diagnosed cases of atherosclerosis of the lower extremities is close to 4%, and after 10 years - twice as often.

Causes

In order for excess cholesterol in the blood to cause such a serious disease as atherosclerosis of the vessels of the lower extremities, included in the international classification ICD 10, there must be a combination of several factors influencing the structure of the arteries:

• Hereditary prerequisites (in persons who have relatives with atherosclerosis, there is a common gene that provokes this disease);
• Being male;
• Elderly age;
• Hypertension;
• Diabetes;
• Adherence to smoking;
• Improper eating behavior;
• Obesity;
• Physical inactivity;
• Frequent physical activity;
• Hypothermia and frostbite of the legs;
• History of leg injuries.

Stages and symptoms of the disease

The severity of symptoms and their nature depend on the degree of development and progression of atherosclerosis of the lower extremities (ICD code 10), the involvement of the arteries of the legs in the process and the blocking of their lumen.

There are 4 stages, differing in clinical manifestations:

• The first stage - the diagnosis is established only by the results of laboratory blood tests that detect excess cholesterol levels. There are no symptoms of the disease that are noticeable to the patient.
• The second stage is characterized by the presence of the first noticeable signs of the disease, including numbness, pain in the lower extremities, the appearance of muscle cramps and chilliness (which is explained by a deterioration in the blood supply to these parts of the body).
• At the third stage, clinical symptoms clearly appear: thinning of the skin on the legs, ease of skin damage and the appearance of wounds; lameness and severe pain in the lower extremities appear.
• The fourth stage is a serious condition. The patient's lameness becomes permanent, persistent pain persists, and the leg muscles atrophy. The development of trophic ulcers and gangrene is likely, which can have fatal consequences including loss of a limb.

If the described signs are identified, if alarming phenomena appear, it is necessary to consult a doctor as soon as possible for examination, diagnosis and treatment. Left unattended, atherosclerosis of the vessels of the lower extremities (ICD code 10) leads to disability.

Diagnostics

Diagnostics consists of:

• Taking anamnesis;
• Assessment of clinical symptoms;
• Instrumental and hardware examination;
• Laboratory examination.

Laboratory tests include blood and urine tests.

Instrumental studies include Dopplerography to determine the characteristics of blood supply in the lower extremities, rheovasography, arteriography, angioscanning and thermography.

Attention is also paid to differentiating atherosclerosis disease (CAD) from thromboangitis and endarteritis.

Treatment

After confirming the diagnosis in a medical institution, the doctor selects the most suitable treatment regimen for the patient, which takes into account the characteristics of the course of the disease, the condition of the body and the stage of the disease.

Treatment can be conservative, with health measures, endovascular or surgical.

Treatment is designed to solve priority problems:

1. Reduce and facilitate the passage of pain in the patient;
2. Promote endurance during everyday walking;
3. Stop the development of plaques in blood vessels and prevent the formation of ulcers.

With conservative treatment, medications are prescribed to restore blood supply to the legs; vitamin complexes; ointments containing antibiotics; local agents that stimulate regeneration; physiotherapy; drugs to improve blood microcirculation.

Endovascular treatment involves acting directly on damaged vessels. These are dilatation, stenting, angioplasty (its essence is the dilation of blood vessels using local anesthesia).

Surgical treatment comes to the rescue if nothing else has helped. Then doctors resort to thromboendarterectomy or bypass surgery (organizing a bypass for blood flow).

With advanced gangrene, in irreversible cases, amputation of the limb is performed.

Any treatment brings the best results with an integrated approach, including drug therapy, household health measures, and natural remedies of traditional medicine.

• Treatment of concomitant diseases that complicate the treatment of atherosclerosis;
• Quitting smoking;
• Rationing of physical activity;
• Protect the lower extremities from hypothermia;
• Control of eating behavior in order to reduce cholesterol and lipids, adherence to dietary recommendations to reduce and normalize weight.

Traditional medicine

• Infusions and decoctions of medicinal herbs: hawthorn, burdock, sweet clover, clover.
• Using decoctions and tinctures to apply medicinal dressings soaked in the decoction. For dressings and applications, decoctions of string, plantain, St. John's wort, sage, chamomile, and moss are used.
• To restore liver function, which is extremely important in the treatment of atherosclerosis, milk thistle or immortelle are used, separately taking their decoction orally.
• The use of artichoke in food as a plant with restorative properties, and garlic tincture.

Prevention

Like any type of atherosclerosis, obliterating atherosclerosis of the lower extremities (ICD 10) is easiest to prevent if you regularly monitor your health and know the risk factors.

You can delay its appearance or eliminate it completely if you make the rule of life a sufficient amount of physical activity, walking in the fresh air, excluding alcoholic beverages and tobacco, reducing the proportion of sweet and flour products in the diet, and an almost complete absence of canned food, fatty, fried, and spicy foods.

It is necessary to avoid hypothermia of the lower extremities, stagnation of blood in them due to uncomfortable shoes and high heels. Sitting in one place for a long time without changing posture also provokes problems with blood circulation.

People with diabetes will help their skin on their legs, especially their feet, if they rub it with a small amount of insulin.

Code of atherosclerosis of vessels of the lower extremities according to ICD-10

Atherosclerotic disease complicated by occlusion can cause thromboembolism, trophic ulcers and gangrene. Diagnosis of any of these problems requires knowledge of the coding of conditions specified in ICD 10. Atherosclerosis of the lower extremities in the International Classification of Diseases, 10th revision, is in section I70 - I79.

Usually, the code of a specific disease is well known to doctors specializing in the treatment of vascular pathology. However, doctors of all specialties may encounter problems with the circulatory system presented in ICD 10, so you should have information on specific conditions that arise against the background of vascular diseases. Blockage of arterial trunks anywhere in the body can manifest itself in a variety of symptoms. Knowing the diagnosis code will help you quickly navigate a large number of vascular diseases.

Group of diseases associated with atherosclerotic lesions

All diseases that occur against the background of uncomplicated or complicated atherosclerosis are systematized under the code I70 and include the following pathology options:

• atherosclerotic disease of the aorta (I70.0);
• damage to the renal arteries (I70.1);
• atherosclerosis of the arteries of the lower extremities (I70.2);
• narrowing of any other arteries caused by pathological atherogenesis (I70.8);
• multiple or unspecified pathological process occurring against the background of atherosclerosis (I70.9).

The doctor can use any code from ICD 10 to indicate a diagnosis of vascular pathology. It is necessary to divide atherosclerosis of the lower extremities into 2 parts - complicated or uncomplicated version. Obliterating vascular atherosclerosis is coded I70.2.

Vascular complications of the legs, systematized in the International Classification

Pathology of the aorta or large main arteries is of great importance for ensuring blood flow in the legs. In particular, if an atherosclerotic plaque has led to disruption of blood flow, then an expansion similar to a saccular aneurysm will form above the narrowing. If atherosclerosis provokes the formation of aneurysmal expansion in the area of ​​the aorta or underlying vessels, then the doctor will set the following code from the 10th revision classification:

• aneurysm of the abdominal aorta with or without rupture (I71.3-I71.4);
• dilatation of the iliac arteries (I72.3);
• aneurysm of the arteries of the lower extremities (I72.4);
• aneurysmal dilatation of specified or unspecified localization (I72.8 -I72.9).

In the group of peripheral vascular pathology, the International Classification of the 10th revision identifies the following pathology options:

• vascular spasm of small arteries or Raynaud's syndrome (I73.0);
• thromboangiitis obliterans, combining inflammation and thrombosis (I73.1);
• specified or unspecified peripheral vascular diseases (I73.8-I73.9).

If atherosclerosis in the area of ​​​​the vessels of the legs causes thrombotic complications, then these types of problems are grouped in the following codes:

• thromboembolism of the abdominal aorta (I74.0);
• thrombosis of the arteries of the lower extremities (I74.3);
• obstruction of the iliac arteries by thrombi or emboli (I74.5).

The obliterating variant of vascular pathology is coded as standard. If severe complications occur (gangrene, trophic ulcers), the ICD 10 code corresponds to the usual code, as does atherosclerosis of the arterial trunks of the femur and leg (I70.2).

Every doctor needs to know and use the International Classification of Diseases codes. In the case of pathology of the blood vessels of the legs, it is important to understand that under one code there can be different options - obliterating or uncomplicated atherosclerosis of the lower extremities. Depending on the preliminary diagnosis, the doctor will use optimal and informative diagnostic methods to confirm the disease variant and choose the best type of therapy. The presence of complications is of great importance: if the doctor sees gangrenous foci, then treatment must be started immediately. However, in all cases, prevention will give the best effect, so you should follow the doctor’s recommendations at the stage of minimal atherosclerotic symptoms, without waiting for skin ulceration or gangrenous lesions of the legs to appear.

The information on the site is provided for informational purposes only and cannot replace the advice of your attending physician.

Obliterating atherosclerosis of the lower extremities

According to the international classification of diseases (ICD 10), obliterating atherosclerosis of the lower extremities is a disease of the leg arteries, characterized by their occlusive-stenotic lesions caused by excessive accumulation of cholesterol and lipids on the walls of blood vessels. Such lipid and cholesterol accumulations, called atherosclerotic plaques in medicine, can significantly increase in size as the disease progresses and thereby provoke the appearance of not only a fairly pronounced narrowing (stenosis) of the lumens of the arteries, but also their complete closure, which in most cases leads to ischemia of the lower extremities.

In order to most fully present the mechanism of pathological changes in this disease, it is recommended to familiarize yourself with medical sources containing various illustrations on the topic, as well as photos of obliterating atherosclerosis of the lower extremities.

Prevalence of the disease

Obliterating atherosclerosis of the arteries of the lower extremities is considered the most common vascular disease. According to generalized data from various medical studies, with atherosclerosis, occlusive-stenotic lesions of the arteries of the legs are found in 20% of patients. It is noted that this disease most often occurs in people belonging to a more mature age category. According to statistics, between the ages of 45 and 55 years, this disease is detected in only 3-4% of people, while at older ages it is detected in 6-8% of the population. It is also important to note the fact that atherosclerotic diseases are most often diagnosed in the male half, and in particular, in those men who abuse tobacco smoking for a long period of time.

Causes of the disease

Medical specialists are inclined to believe that the main reason for the development of the disease in question lies in lipid metabolism disorders, namely in a significant increase in the level of lipophilic natural alcohol (cholesterol) in the blood. However, they also note that the accumulation of cholesterol in the vessels alone is not enough to cause atherosclerosis. In order for atherosclerosis obliterans to develop, in addition to an increase in cholesterol levels, some risk factors must also be present that can adversely affect the structure and protective properties of the artery. Such factors include:

• mature age (45 years and older);
• gender (male);
• smoking (nicotine initiates the appearance of persistent vascular spasms, which often contributes to the development of various pathological processes);
• various serious illnesses (diabetes mellitus, hypertension, etc.);
• unhealthy diet (excess animal fats);
• lack of physical activity;
• overweight;
• excessive psycho-emotional and physical stress;
• frostbite of the extremities, as well as frequent hypothermia;
• previous leg injuries.

Currently, representatives of medicine believe that in addition to all of the above conditional causes of atherosclerosis, there is also a risk factor for the development of atherosclerotic diseases such as genetic predisposition. It has been scientifically proven that in some cases, an excessive increase in cholesterol in a person’s blood may be due precisely to his genetic inheritance.

Classification and symptoms of the disease

Symptoms of obliterating atherosclerosis of the lower extremities and their severity usually directly depend on the nature of the disease itself and on the stage of its development, determined by both the degree of blockage of the artery and the severity of the resulting disturbances in the blood supply in the legs.

Modern medicine identifies four main stages of development of this disease, each of which is expressed by a specific clinical picture. These include:

• Stage 1 (is the initial asymptomatic stage of the disease, diagnosed by taking a biochemical blood test, which reveals elevated lipid levels);
• stage 2 (expressed by the appearance of primary signs of the disease in the form of numbness, chilliness, muscle cramps and mild pain in the lower extremities);
• stage 3 (characterized by a fairly pronounced clinical picture, in which severe pain appears in the legs, lameness may be observed, and thinning of the skin and the formation of small bleeding wounds and ulcers are detected);
• Stage 4 (defined as the most severe and is expressed by the appearance of constant pain, muscle atrophy, total lameness, as well as the occurrence of gangrene and trophic ulcers). Medical specialists warn that obliterating atherosclerosis of the vessels of the lower extremities is a serious and dangerous disease, untimely treatment of which can lead to the appearance of gangrene of the leg with its subsequent loss. This means that if any of the above symptoms occur, it is important to immediately consult a doctor in order to promptly diagnose and treat the developed disease.

Diagnosis of the disease

The diagnosis of “obliterating atherosclerosis ICD 10 code 170” is made on the basis of the collected anamnesis, manifested clinical signs, as well as laboratory and instrumental research methods, including passing some tests (urine, blood) and undergoing a number of special medical examinations (rheovasography, Dopplerography, thermometry, arteriography and functional load tests).

Treatment of the disease

After carrying out all the necessary diagnostic procedures followed by making an accurate diagnosis, the doctor individually prescribes to the patient the most suitable treatment for obliterating atherosclerosis. When drawing up a treatment regimen for this disease, the doctor always takes into account the stage of its development, the severity of existing ischemic disorders and the presence or absence of any complications.

Relief of pathological processes in atherosclerotic diseases can include both a set of therapeutic and health measures aimed at adjusting everyday lifestyle, as well as conservative, endovascular or surgical methods of treatment.

Treatment and health measures in such cases include:

• to give up smoking;
• hypocholesterol diet food;
• elimination of existing diseases and pathologies that aggravate the course of atherosclerosis;
• dosed physical activity;
• prevention of hypothermia of the skin of the legs and feet, as well as their protection from injury.

Treatment of obliterating atherosclerosis of the lower extremities, carried out conservatively, involves the use of physiotherapy, the use of antibiotic ointments, as well as the use of various vasodilators, vitamins, antispasmodics and drugs that improve tissue nutrition and blood microcirculation.

Endovascular treatments include balloon dilatation, angioplasty and arterial stenting. In modern medicine, these treatment methods are considered to be fairly effective non-surgical methods of restoring blood circulation through the vessels.

Surgical treatment is carried out only when a number of severe complications arise against the background of severe ischemia that is resistant to medication. The main surgical methods for treating atherosclerosis of the legs are: prosthetics (replacement of the affected part of the vessel with a prosthesis), bypass surgery (restoration of blood flow using an artificial vessel), thromboendarterectomy (liquidation of the affected artery).

In cases where gangrene appears against the background of atherosclerotic disease, multiple necrosis of leg tissue is observed, and it is not possible to restore blood flow through surgery, amputation of the affected part of the leg is prescribed.

Progressive atherosclerosis is one of the main causes of disability caused by amputation of the lower extremities, and, therefore, for each patient suffering from this disease, it is important to begin in time to carry out all the necessary treatment procedures and strictly follow the basic medical instructions and recommendations.

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Obliterating atherosclerosis ICD 10

Latin name: Fosfobion

Pharmacological groups: Other metabolisms

Nosological classification (ICD-10): I20 Angina pectoris [angina pectoris]. I42 Cardiomyopathy. I48 Atrial fibrillation and flutter. I73 Other peripheral vascular diseases. M15-M19 Arthrosis. R07.2 Pain in the heart area

Active ingredient (INN) Triphosadenine

Application: Muscular dystrophy, myoatrophy, obliterating atherosclerosis of the vessels of the lower extremities, Raynaud's disease, thromboangiitis obliterans, paroxysmal supraventricular tachycardia.

Contraindications: Myocardial infarction in the acute period.

Side effects: Headache, dizziness, tachycardia, nausea, lyuria.

Directions for use and dose: IM - 1 ml of 1% solution 1–2 times a day. The course of treatment is 30–40 injections. Repeated course - after 1–2 months. To relieve paroxysm of supraventricular tachycardia, 1–2 ml of a 1% solution is injected intravenously (the effect occurs after 30–40 s). Repeated administration - after 2–3 minutes.

Latin name: Dalarginum

Pharmacological groups: Other gastrointestinal drugs. Regenerants and reparants

Nosological classification (ICD-10): K25 Stomach ulcer. K26 Duodenal ulcer. K85 Acute pancreatitis

Active ingredient (INN) Dalargin (Dalargin)

Application: Peptic ulcer of the stomach and duodenum, obliterating endarteritis, obliterating atherosclerosis of the vessels of the lower extremities, alcoholism.

Contraindications: Hypersensitivity, hypotension.

Restrictions on use: Pregnancy, childhood (no information on use).

Side effects: Hypertension, allergic reactions; redness and soreness at the injection site.

Directions for use and dosage: IM, 1–2 mg (pre-dilute in 1 ml of isotonic sodium chloride solution), 2 times a day; IV - once a day, 1 mg in 5–10 ml of isotonic sodium chloride solution. Course - 3–4 weeks. The course dose is 30–50 mg. The highest daily dose is 5 mg.

CINNARIZINE

Individual. Take pomg orally 3 times a day after meals. If necessary, treatment can begin with 1/2 dose, gradually increasing it. To achieve an optimal therapeutic effect, use continuously for several months.

From the digestive system: possible dyspeptic symptoms, dry mouth; rarely - cholestatic jaundice.

From the side of the central nervous system: headaches, drowsiness; In elderly patients, long-term use may result in extrapyramidal symptoms and depression.

Others: weight gain, increased sweating; in isolated cases - lupus-like syndrome, lichen planus.

Contraindications for use

Obliterating atherosclerosis code according to ICD 10

Vegetative-vascular dystonia (VSD) is a symptom complex of diverse clinical manifestations that affects various organs and systems and develops as a result of deviations in the structure and function of the central and/or peripheral parts of the autonomic nervous system.

Vegetative-vascular dystonia is not an independent nosological form, however, in combination with other pathogenic factors, it can contribute to the development of many diseases and pathological conditions, most often having a psychosomatic component (arterial hypertension, coronary heart disease, bronchial asthma, peptic ulcer, etc.). Vegetative changes determine the development and course of many childhood diseases. In turn, somatic and any other diseases can aggravate autonomic disorders.

Signs of vegetative-vascular dystonia are detected in 25-80% of children, mainly among urban residents. They can be found at any age, but are more often observed in children 7-8 years old and adolescents. More often this syndrome is observed in girls.

Vegetative-vascular dystonia. Causes.

The reasons for the formation of autonomic disorders are numerous. Of primary importance are primary, hereditarily determined deviations in the structure and function of various parts of the autonomic nervous system, most often traced through the maternal line. Other factors, as a rule, play the role of triggers that cause the manifestation of existing latent autonomic dysfunction.

The formation of vegetative-vascular dystonia is largely facilitated by perinatal lesions of the central nervous system, leading to cerebral vascular disorders, impaired cerebrospinal fluid dynamics, hydrocephalus, damage to the hypothalamus and other parts of the limbic-reticular complex. Damage to the central parts of the autonomic nervous system leads to emotional imbalance, neurotic and psychotic disorders in children, inadequate reactions to stressful situations, which also affects the formation and course of vegetative-vascular dystonia.

In the development of vegetative-vascular dystonia, the role of various psychotraumatic influences (conflict situations in the family, school, family alcoholism, single-parent families, isolation of the child or excessive care by his parents) is very important, leading to mental maladaptation of children, contributing to the implementation and strengthening of autonomic disorders. Equally important are frequently recurring acute emotional overloads, chronic stress, and mental overstrain.

Provoking factors include a variety of somatic, endocrine and neurological diseases, constitutional anomalies, allergic conditions, unfavorable or sharply changing meteorological conditions, climatic features, environmental distress, imbalance of microelements, physical inactivity or excessive physical activity, hormonal changes during puberty, non-compliance with diet and etc.

Of undoubted importance are the age-related characteristics of the rate of maturation of the sympathetic and parasympathetic parts of the autonomic nervous system, the instability of brain metabolism, as well as the inherent ability of the child’s body to develop generalized reactions in response to local irritation, which determines the greater polymorphism and severity of the syndrome in children compared to adults. Disorders that have arisen in the autonomic nervous system lead to various changes in the functions of the sympathetic and parasympathetic systems with impaired release of mediators (norepinephrine, acetylcholine), hormones of the adrenal cortex and other endocrine glands, a number of biologically active substances (polypeptides, prostaglandins), as well as disorders sensitivity of vascular α- and β-adrenergic receptors.

This causes a great variety and varying severity of subjective and objective manifestations of vegetative-vascular dystonia in children and adolescents, depending on the age of the child. Their autonomic changes are often multi-organ in nature with a predominance of dysfunction in any one system, most often in the cardiovascular system.

Classification of vegetative-vascular dystonia

To date, no generally accepted classification of vegetative-vascular dystonia has been developed. When formulating a diagnosis, take into account:

variant of autonomic disorders (vagotonic, sympathicotonic, mixed);

prevalence of autonomic disorders (generalized, systemic or local form);

organ systems most involved in the pathological process;

functional state of the autonomic nervous system;

degree of severity (mild, moderate, severe);

nature of the course (latent, permanent, paroxysmal).

Symptoms of vegetative-vascular dystonia

Vegetative-vascular dystonia is characterized by diverse, often vivid subjective symptoms of the disease that do not correspond to the much less pronounced objective manifestations of a particular organ pathology. The clinical picture of vegetative-vascular dystonia largely depends on the direction of autonomic disorders (predominance of vago- or sympathicotonia).

Children with vagotonia are characterized by many hypochondriacal complaints, increased fatigue, decreased performance, memory impairment, sleep disorders (difficulty falling asleep, drowsiness), apathy, indecisiveness, fearfulness, and a tendency to depression.

Characterized by a decrease in appetite in combination with excess body weight, poor tolerance to cold, intolerance to stuffy rooms, a feeling of chilliness, a feeling of lack of air, periodic deep sighs, a feeling of a “lump” in the throat, as well as vestibular disorders, dizziness, pain in the legs (usually at night). time), nausea, unmotivated abdominal pain, marbling of the skin, acrocyanosis, pronounced red dermographism, increased sweating, sebum secretion, tendency to fluid retention, transient swelling under the eyes, frequent urge to urinate, hypersalivation, spastic constipation, allergic reactions.

Cardiovascular disorders are manifested by pain in the heart area, bradyarrhythmia, a tendency to decrease blood pressure, an increase in heart size due to a decrease in the tone of the heart muscle, and muffled heart sounds. The ECG reveals sinus bradycardia (bradyarrhythmia), possible extrasystoles, prolongation of the P-Q interval (up to atrioventricular block of the I-II degree), as well as a shift of the ST segment above the isoline and an increase in the amplitude of the T wave.

Children with sympathicotonia are characterized by temperament, short temper, mood swings, increased sensitivity to pain, easy distractibility, absent-mindedness, and various neurotic states. They often complain of a feeling of heat and a feeling of palpitations. With sympathicotonia, an asthenic physique against the background of increased appetite, pallor and dry skin, pronounced white dermographism, coldness of the extremities, numbness and paresthesia in them in the morning, an unmotivated increase in body temperature, poor heat tolerance, polyuria, and atonic constipation are often observed. There are no respiratory disorders, vestibular ones are uncharacteristic. Cardiovascular disorders are manifested by a tendency to tachycardia and increased blood pressure with normal heart sizes and loud heart sounds. The ECG often reveals sinus tachycardia, shortening of the P-Q interval, displacement of the ST segment below the isoline, and a flattened T wave.

If cardiovascular disorders predominate in the complex of existing autonomic disorders, it is permissible to use the term “neurocirculatory dystonia”. However, it should be borne in mind that neurocirculatory dystonia is an integral part of the broader concept of vegetative-vascular dystonia.

Atherosclerosis is a polyetiological disease that affects the vascular wall and can manifest itself in different locations at different stages.

Let's analyze one of the most common forms of pathology - atherosclerosis of the blood vessels of the lower extremities - we'll talk about its symptoms and treatment, why it is dangerous and how it can be prevented.

Atherosclerosis of the lower extremities is a disease that affects the endothelium (inner lining) of the blood vessels of the legs. This happens due to an imbalance in lipid metabolism. main reason both atherosclerosis of the aorta and leg arteries - persistently and long-term increased levels of bad cholesterol in the blood. According to the international classification, atherosclerosis of the arteries of the legs has a code according to ICD 10: 170.2.

Plaques in blood vessels in the lower extremities

The disease manifests itself mainly in adulthood and old age, but its laboratory signs can be detected much earlier. Atherosclerosis can develop in the body for decades without showing any symptoms. The main arteries are most often affected. Gradually, the lumen of the vessel is closed by cholesterol plaques, and atherosclerosis takes on a wall-occlusive form. What's so special about her? In this clinical case, sclerotic masses mixed with lipids block the vascular lumen by more than half.

Simultaneously with this, destructive processes occur in the capillary sections of the circulatory system. Due to the occlusion of small collateral arteries, the trophism of the feet and joints is disrupted, and the clinical picture of the disease is formed.

Stages of development and symptoms

Inattention to health and lifestyle contribute to the progression of this disease of the limbs. More severe symptoms and life-threatening complications appear, and new foci of atherosclerotic lesions may appear. Experts distinguish a number of stages of atherosclerosis of the legs:

• Preclinical stage. During this period, there are still no external signs of the disease. But there is already a breakdown in lipid metabolism and the process has started. Trigger factors play a major role in this stage - excess weight, poor diet with excess fatty foods, physical inactivity, old age, and concomitant diseases. All of them accelerate the course of the disease. It is diagnosed only in the laboratory - tests indicate increased total cholesterol and its “bad” components - LDL and VLDL. In parallel with cholesterol, triglyceride levels also increase.
• First stage. During this period, the process of sclerosis of the vessels of the lower extremities has already started, but the clinical picture is not yet clearly expressed. Symptoms are practically absent, they can only appear with extreme loads, prolonged walking or running, and often do not attract due attention.
• Second stage. Here it is already difficult not to notice the manifestations of atherosclerosis. The severity of symptoms increases; even minor sports and physical activities can cause pain in the affected limbs. The maximum walking distance before pain syndrome is 250 meters. At this stage, the process may become chronic. Chronic Ischemia of the Lower Extremities develops - CLI - stage 2A of atherosclerosis.
• Third stage. Short and low-intensity loads cause discomfort and pain. The range of pain-free walking is reduced to 50 meters.
• The fourth stage is trophic disorders. Also found in the literature under the name “terminal”. This is the most severe stage of the disease. Due to total disturbances in the microcirculation of the veins and arteries of the legs and collateral blood supply, trophic non-healing ulcers form on the extremities, the skin darkens, necrotic areas appear (fragments of tissue necrosis), and the supply of oxygen to muscles and tissues is disrupted. Without urgent treatment, these processes can develop into gangrene.

Despite the presence of a long asymptomatic stage, when the patient does not show any complaints, the disease can be detected in the early stages and cured. With the growth of atherosclerotic plaques on the vascular walls, the clinical picture also expands. Usually, first signs– this is numbness of the skin of the feet, a sensation of goosebumps and tingling, a feeling of heaviness in the limbs.

Following this, due to stenosis and decreased vascular permeability, the pulsation of the arteries in the ankles, ankles and popliteal fossae decreases. A very important symptom is severe pain during exercise - which appears when walking. It is the nature, duration and localization of pain that determines how far the destructive process has gone.

Atherosclerotic manifestations in women and men are similar, with the exception that in the stronger half of humanity, the manifestation of the disease occurs in earlier years. The age of increased risk for men is over 40-45 years old, for women – over 50-55.

Diagnostics: how to check leg vessels for atherosclerosis

Before the first serious manifestations of atherosclerosis of the arteries of the lower extremities, the asymptomatic preclinical stage lasts quite a long time. On it, the disease can already be detected both laboratory and instrumental. And as you know, early detection of signs of atherosclerosis is the key to its successful treatment. Let's look at the most modern and effective diagnostic methods and their purpose. These include:

• Magnetic resonance angiography of the lower extremities.
• MSCT angiography.
• Peripheral and collateral arteriography.
• Calculation of pressure and ankle-brachial index.
• Palpation and listening to the pulsation of the vessels of the extremities.
• Duplex angioscanning.
• Consultation with a specialist – a vascular surgeon.

Causes of pathology and risk group

The main factors in the development of atherosclerosis of the lower extremities are metabolic disorders. In particular, a long-term and persistent increase in harmful blood cholesterol.

What is bad cholesterol? This concept usually includes two fractions of this fat - low and very low density lipoproteins (LDL and VLDL). These compounds have the property of sticking both to the wall of the vessel and to each other. When there is an excess of them in the circulating blood, they begin to stick and permeate the vascular wall. Then, in the foci of infiltration, a local inflammatory process occurs, new lipoproteins are layered on top of each other and atheromatous plaques are formed.

Similarly, an important reason for the development of the disease may be hereditary predisposition, which can be seen quite clearly in some patients. If the disease has persistently and steadily developed in close relatives, there is a high risk that it may manifest itself in you.

However, even despite genetic dependence, there are so-called at-risk groups. These are the categories of people in whom atherosclerosis is most likely to develop. These risk groups include:

• overweight people
• patients with underlying diseases - diabetes and/or arterial hypertension, severe infections
• people with negative habits – smoking and alcohol abuse
• males over 40 years of age
• suffering from arthritis - inflammation in the arterial walls of the legs
• patients with irregular diet and lifestyle - excess fatty foods against a background of physical inactivity.

Is it possible to cure atherosclerosis of the lower extremities?

Knowing how the disease develops, what stages it goes through and how it manifests itself, we will consider how to treat atherosclerotic lesions of the veins and arteries of the extremities. And is it even possible to clear the blood vessels on the legs from plaques?

First of all, before any drug treatment, you need to modify your lifestyle and diet. A low-cholesterol diet and dosed physical activity are prescribed. Until the second degree of progression of this vascular disease of the extremities, there is a great chance to improve your health without medications.

The gold standard for the treatment of atherosclerosis of the extremities is a technique developed by doctors in South Korea. It is expensive and is only carried out at their local clinics. The therapy is a cellular intervention - the patient is transplanted a group of stem cells into the lesion. These cells are regenerated and replace the damaged endothelium, clearing it of cholesterol and the patient's condition noticeably improves.

Unfortunately, domestic medicine does not have such technologies. The most common and effective methods in our clinics are restorative, drug and surgical therapy.

Drug treatment

Treatment of atherosclerosis should be comprehensive and individual. The treatment regimen is drawn up by a competent specialist based on test data and objective studies. Drugs from the group of statins (atorvastatin, rosuvastatin) or fibrates (gemfibrozil, fenofibrate), drugs that improve trophism and peripheral circulation in the lower extremities (pentoxifylline) are prescribed. Anticoagulants, vasodilators (vasodilators) and vitamin complexes are also included in therapy.

Insufficient blood supply to the brain with slowing blood flow, a tendency to stagnation, slow reactions of expansion and contraction to external and internal irritations leads to the fact that a patient with cerebral atherosclerosis begins to experience headaches - dull, worsening with fatigue and becoming almost constant over time. . There is often noise and ringing in the head, dizziness with staggering during a sudden change in body position and when walking, redness of the face with sweating or paleness, and sometimes “flying spots” before the eyes. During a long conversation (report, speech), “stumbling” on syllables may occur.
As a rule, sleep is disturbed - it becomes intermittent, with sudden awakenings, palpitations and fears, often with unpleasant dreams, and falling asleep during the day while working is noted.
One of the first symptoms of cerebral atherosclerosis is a decrease in mental activity, weakening of attention, and inability to quickly grasp what is essential. A typical symptom is impaired memory for recent events while intact for long-past events. It is important to note that mechanical memorization is more impaired than logical semantic memory. Along with weakening of mental activity, emotional instability in the form of tearfulness, suspiciousness, anxiety, irritability, pickiness, and grumpiness is typical. Mental “stuckness” is characteristic – slow recovery from the slightest failures, a tendency to depressive reactions.
When examining patients with cerebral atherosclerosis, a number of objective disorders are also revealed. First of all, coordination of movements is impaired. The gait becomes unstable, staggering appears in a standing position, and subtle manipulations with the hands become unclear. The pace of movements slows down, and trembling of the head, chin, or one or both hands may appear. Nystagmus is sometimes noted. The pupils may change their shape, become uneven, and their reaction to light is sluggish. Facial asymmetry is common - one corner of the mouth is lower than the other, the tongue deviates to the side when protruding. Even with normal blood pressure, the pulsation of the vessels in the neck becomes visible, the temporal arteries become tortuous, and the pulsation in the arteries may weaken. When pressing on the arteries, their pain is noted. When examining the fundus, narrowing of the arteries and tortuosity of the veins are detected.
The blood cholesterol level is elevated (more than 250 mg per 100 ml). X-rays of the skull often reveal calcification of the internal carotid and basilar arteries supplying the brain.