The following additional codes are used to indicate the presence or absence of gangrene, for optional use with the appropriate subcategories in I70.
- 0 no gangrene
- 1 With gangrene
Excludes: atherosclerosis of renal arterioles (I12.-)
Sclerosis (medial) Menckeberg
In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to apply 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. №170
The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.
With amendments and additions by WHO.
Processing and translation of changes © mkb-10.com
ICD-10: I70 - Atherosclerosis
Chain in classification:
4 I70 Atherosclerosis
Diagnosis with code I70 includes 5 clarifying diagnoses (ICD-10 subcategories):
The diagnosis also includes:
arteriolosclerosis arteriosclerosis arteriosclerotic vascular disease atheroma degeneration:
Vascular deforming or obliterating endarteritis senile:
The diagnosis does not include:
- cerebral (I67.2) coronary (I25.1) mesenteric (K55.1) pulmonary (I27.0)
multifocal atherosclerosis mcb 10
Atherosclerosis: article catalog
catalogue of articles
How to avoid the consequences of cerebral atherosclerosis?
In the treatment of cerebrovascular disease, it is important to detect cerebral atherosclerosis as early as possible and start treatment in a timely manner.
If you or your loved ones have symptoms of cerebral atherosclerosis (impaired memory, sleep, headaches, dizziness, tinnitus), you should immediately consult a doctor.
Our specialists have developed and patented effective methods for diagnosing atherosclerosis, which make it possible to judge the severity of damage to cerebral vessels.
Treatment of atherosclerosis of cerebral vessels
For the treatment of cerebral atherosclerosis, various drugs are used, adherence to a certain diet. These efforts can lower blood cholesterol levels and slow down the development of atherosclerosis. But, unfortunately, none of the types of drug therapy is able to eliminate the already existing atherosclerotic layers in the vessels. It is possible to reduce cholesterol plaques only by applying the methods of extracorporeal hemocorrection.
The most serious complication of obliterating atherosclerosis of cerebral vessels is acute cerebrovascular accident. This complication is divided into two groups: transient ischemic attack of the brain and stroke.
Transient ischemic attack of the brain is a neurological deficit syndrome that completely regresses within the next 24 hours (most often within 30 minutes). A transient ischemic attack is a precursor to a stroke.
Stroke is a syndrome characterized by the acute development of a neurological deficit that persists for at least 24 hours and is associated with focal brain damage due to cerebrovascular accident.
The main causes of atherosclerosis of the carotid arteries and methods of treatment
Atherosclerosis of the carotid arteries is one of the most dangerous forms of the disease, as it directly affects the human brain.
Symptoms and types of atherosclerosis
Initial atherosclerotic changes are almost asymptomatic. This is the main danger of pathology. In most cases, it is possible to determine the presence of the disease at an early stage by chance, during the diagnosis of other disorders.
Early signs of damage are rare and usually indicate the rapid development of atherosclerosis. The patient should pay attention to the following symptoms:
- location of the arteries Numbness - begins for no apparent reason, localized on one side of the body.
Even if one of the above signs has been observed for a limited amount of time, it is urgent to consult a doctor for advice. A temporary lack of blood supply is a sign of a transient ischemic attack and can lead to a stroke.
Disease history
Multifocal atherosclerosis with lesions of the brachiocephalic branches of the aortic arch, coronary arteries, arteries of the lower extremities
Date of admission to the clinic: 14.09.05
Diagnosis at admission: Multifocal atherosclerosis. Atherosclerosis of the brachiocephalic trunk and arteries of the lower extremities
Complaints
To increase blood pressure to 145/120 mm Hg
For headaches in the parietotemporal region on the right
For dull, aching pain in the heart area with little physical exertion
For sharp pains in the throat, radiating to the left arm and shoulder
For pulling pains in the right leg
On unsteady gait
ANAMNESIS MORBI
He considers himself ill since 2002, when, after physical exertion, there were sharp pains in the throat, radiating to the left arm and shoulder, accompanied by acute headaches in the parietotemporal region on the right and an unsteady gait, manifested in the fact that the patient, due to a shift in the center of gravity tumbled to the left. Such episodes appeared once a month and passed on their own after the cessation of physical activity. From about the same time, pulling pains along the anterior-lateral surface of the right thigh began to disturb when walking a considerable distance (hiking in the forest for mushrooms).
With these complaints, the patient went to the city polyclinic to a neurologist, who was first diagnosed with an increase in blood pressure.
Vascular Surgery #2
The Department of Vascular Surgery No. 2 was organized in 2006 as part of the Center for Cardiovascular and Endovascular Surgery of the Clinical Hospital No. 119. The department employs highly qualified specialists with extensive surgical experience who perform a wide range of elective and emergency operations on the aorta and its branches, brachiocephalic arteries (including carotid arteries), limb arteries, main veins, in case of varicose veins and its complications, as well as operations for injuries of the main vessels. Along with reconstructive operations (bypass surgery, prosthetics), low-traumatic intravascular (endovascular) interventions (balloon angioplasty, stenting and endoprosthetics) of the aorta, its branches, organ arteries and arteries of the extremities are performed. Endovascular operations are performed through a puncture or a small incision in the artery and with the help of special instruments under X-ray control, the damage to the aorta and arteries is corrected. A large section in the work of the department is represented by hybrid operations, when both reconstructive and endovascular operations are performed simultaneously (during one intervention) in the conditions of an X-ray operating room. The presence in the arsenal of the department of various methods of surgical treatment allows providing highly effective assistance to patients with multifocal atherosclerosis, that is, with lesions of several vascular regions. In this category of patients, one-stage or staged treatment is carried out, including with the participation of cardiac surgeons.
The main directions of treatment:
Stenosing atherosclerosis: when the vessels of the lower extremities are affected
Stenosing atherosclerosis of the vessels of the lower extremities is one of the three cardiovascular diseases - sad leaders in terms of the number of causes of death. This disease affects 3-5% of people over the age of 40. The first symptoms of the disease are nonspecific. This is the reason for diagnostic errors in the early stages of the disease. Early treatment will save the health, and sometimes life, of the patient.
In the International Classification of Diseases 10th revision (ICD-10), atherosclerosis of the vessels of the legs belongs to the heading "Diseases of the arteries, arterioles and capillaries". This disease according to ICD-10 has the code I70.2 - "atherosclerosis of the arteries of the extremities."
Atherosclerosis of the arteries of the legs: who is at risk
Atherosclerosis is a disease that affects all the arteries in the body. Its essence lies in the fact that free fats, mainly cholesterol, are deposited in the walls of blood vessels, under their inner shell. Cholesterol plaques are formed in all arteries of the body. Atherosclerosis of the lower or upper extremities, arteries of the head and neck, arteries of the heart may develop. Plaques do not form in the walls of the veins. The reason is that blood pressure in the venous bed is lower, so cholesterol is not deposited in the walls of the veins.
Plaque formation is not a mechanical process. It has various reasons. Fats in the bloodstream bind to special carrier proteins. In some people, the balance in the fat (lipid) transport system is disturbed. This condition is called dyslipidemia. Various types of dyslipidemia have been described. All of them contribute to the development of atherosclerosis.
It is also important in what condition the vascular wall itself is. If the inner lining of blood vessels - the endothelium - is damaged, then cholesterol penetrates the wall more easily. Damage to the vascular wall is caused, for example, by smoking or fluctuations in sugar levels in diabetes mellitus. Not the least role in the development of atherosclerosis is played by genetic predisposition. Many forms of dyslipidemia are "familial", that is, they are inherited.
Stenosing atherosclerosis of the vessels of the lower extremities often develops in representatives of the following groups:
Multifocal atherosclerosis
Atherosclerosis is a vascular disease caused by a disturbed lipid process.
During the formation of atherosclerosis, cholesterol is deposited on the vascular walls, because of this, an atherosclerotic plaque is formed.
Atherosclerotic plaques narrow the vascular lumen.
Atherosclerosis is considered one of the serious diseases that affects many arteries, and if the disease develops rapidly, and treatment does not occur, it can end in disability or death of the patient.
Like other diseases, atherosclerosis has several forms, we will consider the most severe - multifocal type of atherosclerosis. With the development of a multifocal form of pathology, vessels are affected, and not one group, but several vascular groups at once. This leads to the fact that the geodynamics of the body is disturbed. Disturbed geodynamics complicates the process of diagnosis and, accordingly, treatment. The complexity of multifocal atherosclerosis lies in the fact that it leaves severe consequences that affect the entire body.
If multifocal atherosclerosis is diagnosed in the lower limb, then most likely it ends with amputation. Today, patients with this diagnosis require special attention.
As a rule, they are under the strict supervision of doctors until the treatment is over and the result is visible. Doctors conduct various studies to finally study this pathology.
Causes of multifocal atherosclerosis
The causes of the pathology directly depend on where the lesion of the vascular pool is localized. The multifocal type of atherosclerosis of the lower extremities mainly develops as a result of smoking and diabetes mellitus. Genetic predisposition also plays a major role in development.
Also, the cause is food containing cholesterol levels that exceed the norm. By the way, cholesterol also causes coronary atherosclerosis.
At risk are people who:
- lead an unhealthy lifestyle;
- smoking and drinking excessively;
- have reached age, at this age, multifocal atherosclerosis is diagnosed more often;
- had relatives with the same disease. This triples the risk of developing atherosclerosis;
- suffer from impaired functions of the musculoskeletal system;
- not properly and not fully fed.
More often the disease is diagnosed in males than in females.
Symptoms
Atherosclerosis of the multifocal type is asymptomatic. Pathology may not manifest for a long time. It depends on the collateral blood supply, the severity of the disease and the location of the focus.
In medical practice, cases have been recorded when the vessels were completely clogged, but no symptoms were observed.
Vivid symptoms appear when thromboembolic and hemodynamic mechanisms begin in the body. The thromboembolic mechanism is characterized by the formation of white blood clots on atherosclerotic plaques. A white thrombus develops unexpectedly, in which case an embolism begins (the gaps of the blood vessels overlap.
Due to the hemodynamic process, the patient's blood pressure drops sharply and the blood flow in the lesions decreases.
Diagnostics
Diagnosis of multifocal atherosclerosis consists of many activities.
- To begin with, specialists need to collect a complete patient history. study the entire medical history. To exclude other serious pathologies.
- Then an external examination is carried out, the affected areas are palpated, tapped, and listened to, in a simple way, this is called the primary physical examination.
- Explore and record the electric fields that are formed as a result of cardiac work. The electrophysical work of the heart muscles is also examined.
- Continuously monitor the work of the heart and fix it on the cardiogram. With the help of a Holter examination, it is possible to continuously monitor the work of the myocardium, evaluate cardiac activity during exercise and at rest, and also record the smallest deviations.
- With the help of ECG, the functionality of the cardiovascular system is assessed. An electrocardiograph records electrical currents during relaxation and contractions of the heart muscles.
- Doppler ultrasound is used to study blood vessels and blood flow.
- Transcranial dopplerography will help to fully and reliably study the structure and activity of the functioning of the brachiocephalic artery and veins.
- With the help of duplex scanning, the degree of patency of the lumen and its change in diameter are assessed.
- You also need to undergo an ultrasound examination of all internal organs.
- Carrying out echocardiography of the cavity checks the work of the heart and evaluates its contractile activity.
- X-ray examination studies the structure and functions of all vital organs.
- It is also necessary to identify insufficiency of the heart arteries, if any, for this, a dobutamine and nitroglycerin test is performed.
- As with any other disease, the patient undergoes standard tests, this is a urinalysis and a complete blood count.
- Radioisotope technique allows you to study the work of the kidneys.
- To exclude coronary heart disease, it is necessary to evaluate the coronary artery, for this the patient undergoes coronography.
- To assess the functioning of the brain and its ventricular system, ventriculography is performed.
- The condition and functionality of the aorta is determined by aortoarteriography.
Treatment
The multifocal form of atherosclerosis differs from others in that extensive vascular damage occurs, so many examinations are required to diagnose pathologists. Based on the results obtained, doctors select an effective treatment. Treatment of multifocal atherosclerosis takes place in the complex.
It is worth noting that if the disease progresses rapidly, then the patient has less and less chance of a complete cure. Delaying treatment contributes to an increase in the frequency of severe consequences and complications after the operation.
If, when diagnosing a multifocal form of atherosclerosis, doctors detected a stroke, myocardial infarction, or an acute form of coronary heart disease, the patient is immediately hospitalized and urgent treatment is carried out. The specialists have two main tasks:
- prevention of further thrombosis;
- if necessary, remove all thrombi.
When doctors diagnose a multifocal type of atherosclerosis at the initial stage of its development, the patient undergoes drug treatment, which includes drugs:
- normalizing the exchange of lipids in the blood;
- lowering cholesterol levels. The preparations contain nicotinic acids, which increase lipoproteins;
- overwhelming causes of the development of pathology and negatively affecting the accumulation of cholesterol.
The most common drugs for the treatment of multifocal atherosclerosis are:
- Clopidogrel is prescribed for the prevention of thrombosis. Doctors prescribe it mainly to those patients who have a predisposition to atherosclerotic disease;
- Aspirin is considered one of the traditional drugs that prevents the formation of blood clots in the vessels. This drug has the ability to thin the blood, and copes with this task by 100%. But it should be used only on the advice of a doctor.
- for stroke patients, doctors prescribe dipyridamole. It has the same properties as aspirin and clopidogrel, and is prescribed when, for some reason, the patient cannot use the above drugs.
Today, specialists often combine these drugs, thereby achieving a greater effect. If the patient follows all the recommendations of specialists, then one medicine complements the other with its properties.
For several 10 years, doctors have been prescribing aspirin along with dipyridamole, they believe that this combination is very effective. This combination is used in the treatment of patients with cardiac ischemia or stroke. The combination of Aspirin with Clopidogrel is prescribed for acute coronary syndrome.
In addition to drug therapy, the multifocal form of atherosclerosis can be treated with:
- thrombectomy, which normalizes blood circulation. Thrombectomy is a surgical operation that involves a small incision in the blood vessels. A catheter is inserted into this incision to suck out blood clots. The operation is carried out carefully, while not allowing to hit other vascular walls.
- with cerebral or coronary occlusion, doctors perform thrombolytic therapy. This type of treatment is prescribed for patients with ischemic stroke and acute coronary syndrome.
- modern medicine has found another way to treat multifocal atherosclerosis, this is endovascular removal. This type of treatment is still at the stage of study, but all the experiments that have been completed have ended in success.
For each patient, one of these types of treatment is selected, according to the individual characteristics of the body and the complexity of the pathology.
Classification of atherosclerosis
Clinical classification of atherosclerosis
other vasomotor disorders
constitutional and hereditary disorders of lipid metabolism
endocrine diseases (DM, hypothyroidism, gonadal insufficiency)
atherosclerosis of the coronary arteries
atherosclerosis of the aorta and its branches
atherosclerosis of cerebral arteries
atherosclerosis of the renal arteries
atherosclerosis of the mesenteric arteries
atherosclerosis of peripheral arteries
III. Development periods:
b) atherosclerosis with a latent course
period of clinical manifestations
Stage I - ischemic
II stage - necrotic (thrombonecrotic)
III stage - fibrous
IV. Development phases
progression phase (active)
stabilization phase (inactive)
regression phase (remission)
V. Morphological stages
Recently, doctors are increasingly switching to the international classification of atherosclerosis according to ICD-10.
Classification of atherosclerosis (mkb - 10)
I 70. Atherosclerosis.
I 70.0. atherosclerosis of the aorta.
I 70.1. Atherosclerosis of the renal arteries.
I 70.2. Atherosclerosis of the arteries of the ending.
I 70.9. Generalized and unspecified atherosclerosis.
I 67.2. Atherosclerosis of cerebral vessels.
I 25.1. Atherosclerosis of the coronary vessels.
By 55.1. Atherosclerosis of the mesenteric vessels.
Clinical manifestations of atherosclerosis:
IHD (angina pectoris, myocardial infarction, cardiosclerosis, rhythm and conduction disturbances, acute or chronic heart failure);
Acute (strokes) or chronic disorders of cerebral circulation;
Arterial hypertension, primarily systolic, with damage to the aortic arch and its ascending part;
Thrombosis of mesenteric vessels, "abdominal toad";
Intermittent claudication, gangrene of the extremities;
AS of the renal arteries with the development of renovascular hypertension, with the formation of Goldblatt's kidney.
Clinical manifestations quite often do not correspond to morphological changes. In a pathological anatomical incision, a widespread and pronounced atherosclerotic vascular lesion may be an accidental finding. On the contrary, the clinic of severe ischemia of the organ may appear with moderate obliteration of the lumen of the vessel. Characteristic is the predominant lesion of certain arterial basins, on which the clinical picture of the disease primarily depends. Even within individual arterial basins, cellular lesions are characteristic - with the involvement of typical areas and the preservation of neighboring ones. Thus, among the vessels of the heart, the proximal anterior interventricular branch of the left coronary artery is most often affected. Also typical localization is the proximal part of the renal artery and the bifurcation of the carotid artery; and, for example, the internal thoracic artery is rarely affected. Atherosclerotic plaques often occur at arterial bifurcations, where blood flow is uneven. Nevertheless, always (with the exception of aortic AS) the clinic is predetermined by the manifestations and consequences of tissue or organ ischemia, which depend both on the degree of vasoconstriction and on the development of collaterals.
Atherosclerosis of the thoracic aorta
Aortalgia is a pressing pain behind the sternum that radiates to the shoulder, neck, back, and upper abdomen. The pain is not paroxysmal, prolonged. With a significant expansion of the aortic arch or aneurysm, there is difficulty in swallowing due to compression of the esophagus, hoarseness, dizziness, and convulsions with a sharp turn of the head. On auscultation - a shortened II tone with a metallic tint, systolic murmur, which increases when the arms are raised up and the head is tilted back (Sirotinin-Kukoverov symptom).
Atherosclerosis of the abdominal aorta
Pain in the abdomen of different localization, bloating, constipation as a manifestation of dysfunction of the abdominal organs due to narrowing of various arterial branches that extend from the aorta.
With atherosclerotic lesions of the aortic bifurcation, Leriche's syndrome develops - blockage of the aorta: intermittent claudication, coldness and numbness of the legs, atrophy of the muscles of the lower leg, impotence, ulcers and necrosis in the area of the fingers and feet with edema and hyperemia, lack of pulsation of the artery of the feet, popliteal artery, absence of pulsation of the aorta at the level of the navel, systolic murmur over the femoral artery in the inguinal fold. Above the abdominal aorta, a systolic murmur is heard in the midline above and at the level of the umbilicus.
Diagnosis of atherosclerosis, especially in its early stages, is a very serious problem. The diagnosis is based on the clinical manifestations of lesions of various organs, data from laboratory and instrumental studies, risk factors, etc.
AS diagnostics includes:
Questioning the patient and identifying clinical symptoms depending on the lesion and localization;
General examination of the patient: signs of aging, especially premature, significant hair growth in the auricles, a white border along the outer edge of the iris, xanthoma and xanthelasma, systolic murmur over the aorta, etc.
Determination of cholesterol and lipid spectrum of blood;
Angiographic examination (detection of vascular stenoses);
Doppler ultrasonography of blood vessels (detection of blood flow disorders);
Plain x-ray examination of the chest organs (detection of morphological changes in the heart and aorta);
Ultrasound examination of the heart and abdominal organs (detection of calcifications in the wall of blood vessels);
Magnetic resonance imaging of the brain.
Laboratory determination of blood lipid spectrum
Most often, only three of the components of the lipid spectrum are determined by the laboratory, namely: cholesterol, TG and HDL cholesterol. Prognostically significant LDL cholesterol in this situation is calculated using the Friedewald* formula:
In mmol/l: LDL cholesterol = total cholesterol - HDL cholesterol - (0.45 x triglyceride level);
in mg/dl: LDL cholesterol = total cholesterol - HDL cholesterol - (0.2 x triglyceride level).
* The calculation is only valid if the triglyceride concentrations are less than 4.5 mmol/L (400 mg/dL). An error in determining HDL-C or in determining TG in patients who have violated dietary recommendations before donating blood can steadily cause an error in calculating the most prognostic LDL-C!
To prevent the occurrence of an error in the "European recommendations for the prevention of cardiovascular diseases in clinical practice" it is recommended to determine non-HDL cholesterol on an empty stomach. This cholesterol is found in LDL, HDL, VLDL. Calculated by simply subtracting HDL cholesterol from total cholesterol, non-HDL cholesterol, unlike LDL cholesterol, does not require triglyceride levels to be less than 5 mmol/L. This indicator, like ups, is used to determine the degree of atherogenicity of lipoproteins in plasma and is more accessible than the determination of ups. Physicians who use non-HDL cholesterol levels to assess CVD risk in patients should consider the target level of therapy to be< 4 ммоль/л (150 мг/дл).
Determining the Risk of Total Cardiovascular Mortality Using the SCORE System
Patients with certain cardiovascular diseases represent a high risk group for developing cardiovascular complications. They need the most intensive lifestyle modification and, if necessary, the appointment of drug therapy. At the present stage, it is proposed to use a model for determining the overall risk based on the SСORE system (Systematic Coronary Risk Evaluation - Systematic Coronary Risk Evaluation), first introduced in the ESC recommendations in 2003. Practitioners should determine the overall risk for CVD in order to intensify preventive measures, t .e. if it is necessary to carry out dietary measures, individualize physical activity, prescribe drug therapy, adapt the dosage of drugs or their combinations to control risk factors.
Total CV risk can be easily calculated using a chart where physicians and patients are encouraged to use the SCORE system to determine total CV risk and ways to reduce it (both lifestyle modification and drug therapy) according to proven efficacy and safety in a multicenter study .
The SCORE system allows you to determine the total cardiovascular risk that is predicted by the age of 60. It may be especially important for prognosis in young patients with low absolute risk at age 20 and over, but already with an unfavorable risk factor profile that would place them in a higher risk category that will progress with age.
1. Patients with an established cardiovascular disease (patients with any clinical manifestations of coronary artery disease, with peripheral atherosclerosis, cerebral artery atherosclerosis, abdominal aortic aneurysm).
2. Asymptomatic patients who have:
Multiple risk factors that define a 10-year risk of 5% or more now and after age 60.
Significantly elevated levels of a single risk factor: total cholesterol > 8 mmol/l (320 mg/dl); LDL cholesterol > 6 mmol/L (240 mg/dL); BP > 180/110 mmHg Art.
Type 2 diabetes mellitus or type 1 diabetes with microalbuminuria.
3. The closest relatives of patients with early onset of CVD: in men under the age of 55 years, in women - 65 years.
1. Improving the quality of life of the patient.
2. Continuation of the patient's life expectancy.
The goal of treating the patient is achieved by solving the following tasks.
1. Decrease in the blood to normal elevated levels: cholesterol, cholesterol LDL and triglycerides.
2. An increase in the blood to normal levels of a reduced level of HDL cholesterol.
3. Prevention of the progression of various clinical forms of atherosclerosis (angina pectoris, etc.).
4. Prevention of complications of atherosclerosis (stroke, myocardial infarction, etc.).
Comprehensive treatment of patients with AS includes:
Lifestyle correction.
Following an appropriate diet.
Conducting drug therapy.
Drug treatment of hypercholesterolemia is started when there is no effect after an adequate 6-month hypocholesterolemic diet.
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What is multifocal atherosclerosis
Atherosclerosis is a systemic chronic vascular disease. As a rule, lesions are not limited to one area, in these cases we are talking about multifocal atherosclerosis.
Atherosclerosis is the cause of impaired blood flow through the vessels and has a very poor prognosis. Multifocal atherosclerosis of the coronary arteries can cause myocardial infarction, and damage to the vessels of the lower extremities can lead to amputation.
According to ICD-10, generalized and unspecified atherosclerosis is assigned the code 170.9.
- All information on the site is for informational purposes and is NOT a guide to action!
- Only a DOCTOR can make an EXACT DIAGNOSIS!
- We kindly ask you DO NOT self-medicate, but make an appointment with a specialist!
- Health to you and your loved ones!
Statistics
According to some reports, the incidence of multifocal atherosclerosis is 50-60%.
According to the Atherosclerosis Clinical Manifestation Registry, this rate is 20% for patients with lesions in more than one pool and about 2% for people with impairments in all three pools.
Taking into account asymptomatic lesions, this figure is several tens of percent.
Causes
The reasons for the development of atherosclerosis are largely related to the damage of which particular vascular region is observed. In coronary atherosclerosis, the cause is an excess of cholesterol levels.
An additional danger in multifocal atherosclerosis of the lower extremities is diabetes mellitus. Arterial hypertension has a significant influence on the development of stroke. With any of the three options, smoking is a dangerous factor that aggravates the patient's condition.
The course of atherosclerosis is complicated by the fact that the defeat of one vascular region causes damage to another. There are many risk factors, and they are divided into removable and irremovable:
- limited motor activity;
- smoking;
- improper nutrition.
- gender - up to 55 years, men predominate among patients, subsequently this indicator loses its relevance, since at an older age the disease equally affects patients of any gender;
- age factor, especially after years;
- genetic predisposition.
Symptoms
Not always multifocal atherosclerotic lesions are accompanied by the simultaneous occurrence of symptoms of the disease.
The manifestation of symptoms can be delayed in time, and the duration of this period will depend on the degree of damage and the degree of development of collateral (lateral) circulation. There are cases in which, even with a completely blocked vessel, there is no pronounced manifestation of symptoms.
Pronounced signs are observed due to violations of hemodynamic and thromboembolic mechanisms. With hemodynamic disorders, there is a drop in blood pressure and a decrease in blood flow in the affected pool.
In the thromboembolic mechanism, a thrombus is formed on the layer lining the inner surface of the vessels (endothelium) caused by platelet activation. As a result, a thrombus can break off and lead to an embolism.
Acute conditions are preceded by circulatory disorders. For example, a stroke may be a precursor to a transient ischemic attack, and a myocardial infarction may be an unstable angina. With atherosclerotic lesions of the lower extremities, their critical ischemia is observed.
Diagnostics
Diagnosis is a multi-stage process and includes the following steps:
- analysis of complaints and medical history of the patient;
- initial physical examination;
- electrocardiography;
- Holter monitoring;
- bicycle ergometry;
- ultrasound and transcranial dopplerography;
- duplex scanning;
- Ultrasound of internal organs;
- echocardiography;
- x-ray examination;
- dobutamine and nitroglycerine tests;
- blood and urine tests;
- radioisotope methods for studying the kidneys and myocardium;
- coronary angiography;
- ventriculography;
- aortoarteriography;
- digital subtraction angiography.
What is multiple atherosclerosis, why is it dangerous and what treatments are most effective, read on.
Treatment
Since disorders in one pool increase the likelihood of damage to other vascular regions, a detailed study of the state of all three pools is required.
With the development of a transient ischemic attack, it is necessary to hospitalize the patient for constant monitoring of his condition, since during the first 2 weeks there is a high probability of a stroke.
Stroke, myocardial infarction and ischemic diseases of the extremities are a direct indication for emergency diagnosis, placement of the patient in a hospital and the use of intensive care measures.
- Thrombectomy has long been used to restore normal blood flow to the extremities. This is a surgical procedure in which a small incision is made through which a blood clot is sucked out by a catheter.
- This excludes damage to the walls of blood vessels, the operation is considered sparing and safe.
- A relatively new way to eliminate a thrombus is endovascular removal.
- This method is still the object of clinical studies, which show good results.
- In acute occlusion of the coronary and cerebral arteries, thrombolytic therapy is used. In ischemic stroke, this method has certain nuances associated with the susceptibility of brain damage to hemorrhagic transformation, which, combined with the limited space inside the cranium, can lead to death.
- According to existing recommendations, the therapeutic window is 3 hours, i.e. it is during this period after the onset of a stroke that treatment should be started. To date, attempts are being made to increase this gap.
- Acute coronary syndrome, accompanied by a rise in the ST segment, involves the use of other thrombolytic drugs: streptokinase, reteplase, tenecteplase, which are injected into a vein. In this case, the duration of the period from the debut can reach up to 12 hours, in some cases - up to a day.
- Anticoagulant therapy is used to prevent the development of thrombosis and the formation of new blood clots. The appointment of heparin and its derivatives is widespread in acute thrombosis of the peripheral vascular system, in acute coronary syndrome.
- There are no fully confirmed data on the correct use of this drug in ischemic stroke, which is associated with an increased risk of complications, and the small molecule drug did not show the desired effect in clinical trials. However, in some cases, for example, in cardioembolic stroke, such therapy is effective and does not give complications.
- At an early stage of a stroke, aspirin is prescribed as an effective thromboembolic therapy. But with the defeat of the lower extremities, the effect of its use has not been confirmed.
- Acute coronary syndrome involves the appointment of clopidogrel, as well as its combination with aspirin. The beginning of treatment implies its use in a volume of 300 or 600 mg. At an early stage of ischemic stroke, the drug is not used.
- Acute coronary syndrome also implies the use of platelet GP receptor antagonists, which are characterized by a high antiplatelet ability.
- To a sufficient extent, the effectiveness of these drugs has not been confirmed by clinical studies.
- Of particular interest at the moment is the combination of various drugs in order to obtain the maximum therapeutic effect.
- It is used to block several pathways of platelet activation, this is important to prevent the development of resistance to the drug used in the appointment of a single drug.
- The effectiveness of combining aspirin with dipyridamole in the treatment of patients with transient ischemic attack and stroke, aspirin with clopidogrel in cases of acute coronary syndrome has been proven.
Surgical repair of vessels is widespread and can be applied in various vascular regions.
- They are prescribed for acute coronary syndrome, as well as multi-vessel lesions.
- These methods constitute an alternative to coronary artery bypass grafting, as well as shunting for atherosclerosis of the lower extremities with proximally located non-extended single stenoses.
- Also, angioplasty and stenting are used to restore the patency of the renal arteries in case of steno-occlusive lesions.
- For elderly patients with comorbidities, as well as in the presence of a thrombus in a hard-to-reach place or with restenosis, this method is more often used. After the intervention, aspirin is prescribed in combination with clopidogrel.
The use of surgical intervention is characterized by some features:
- Simultaneous implementation of several interventions is indicated in cases of critical lesions, as the risk of complications increases significantly. Step by step treatment is recommended.
- Treatment begins with the region where the most serious lesion or unstable clinical situation is observed. This makes it possible to reduce the likelihood of developing situations that can lead to death: ischemic stroke, myocardial infarction.
- Endovascular revascularization has an advantage over surgical intervention, since it can be safely carried out for the patient in several pools at the same time.
Prevention
- healthy lifestyle;
- proper nutrition and monitoring the level of cholesterol in the blood;
- to give up smoking;
- moderate physical activity.
- It involves taking antiplatelet drugs: aspirin, clopidogrel, dipyridamole.
- Antihypertensive, hypolipidemic, antidiabetic agents can also be prescribed.
Here you will find complete information about what is atherosclerosis of the carotid arteries.
In another article there is a description of generalized atherosclerosis.
With a disease such as atherosclerosis, cholesterol begins to deposit on the walls of the arteries. As a result, the lumen of the vessels narrows, damage to the endothelium occurs. Over time, atherosclerotic plaques form. They are a kind of growths, partially or completely clogging the lumen of the vessel. The composition of the neoplasm contains cholesterol, calcium and other foreign substances.
It should be noted that atherosclerosis can be diagnosed in young people. Individual varieties of the disease have been assigned their own code according to the international classification of diseases (ICD 10):
- 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.
Generalized and unspecified form of atherosclerosis was assigned the code I70. 9.
Causes of the appearance of pathology
Atherosclerotic plaque is formed under the influence of various reasons:
- High blood pressure.
- The presence of excess weight.
- The predominance in the diet of products containing fats of animal origin.
- Sedentary lifestyle.
- Excessive addiction to alcoholic beverages.
- Elderly age.
Plaques often appear in people with high sugar content in the body.
How are atherosclerotic plaques formed?
The following stages of plaque appearance should be distinguished:
- A certain amount of cholesterol accumulates in the wall of the artery.
- Monocytes are included in the pathological process. They penetrate the walls of blood vessels.
- Then macrophages are formed. They are cells of the body that absorb various foreign particles. Macrophages have a foamy structure. At this stage, pathological changes occur on the inner surface of the artery.
- After this, platelets attach to the affected area of the vascular wall.
Subsequently, a lot of collagen and elastin accumulate in the endothelium, plaques gradually increase in size.
Composition of neoplasms
The structure of an atherosclerotic plaque is quite complex. It is made up of lipids. In addition, the plaque contains connective tissue fibers. The neoplasm resembles a nucleus surrounded by a thin membrane. The core contains esters and cholesterol. The outer part of the neoplasm is located in the region of the lumen of the artery. This part is essentially a fibrous membrane, which contains collagen and elastin.
Initially, neoplasms have a semi-liquid structure, as a result of which they can come off and block the lumen of the vessel. Therefore, if atherosclerotic plaques were found in a patient, treatment of the pathology should be started immediately.
Then calcium accumulates in the shell of the lipid growth. Therefore, the plaque becomes denser, the blood supply to the body deteriorates markedly.
Varieties of neoplasms
Plaques can have a different structure and size. By structure, all growths are divided into two types: unstable and stable. As part of unstable plaques, there are mainly fats. Such neoplasms are more loose. If a person has unstable plaques, there is a high probability of its rupture with the formation of a blood clot. In this case, the lumen of the vessels is blocked.
Stable growths contain many collagen fibers. They have elasticity. Such growths slowly increase in size. Complicated forms include heterogeneous atherosclerotic plaque. It has a loose structure, so the patient may experience hemorrhage.
Diagnosis of the disease
If you suspect the presence of cholesterol plaques, the following diagnostic measures are used:
- Examination of the patient.
- Laboratory blood tests.
- Ultrasound examination of blood vessels, which provides complete information about the structure of blood vessels.
- X-ray showing an enlarged aortic window.
It is necessary to distinguish a cholesterol plaque from other ailments:
- Atherosclerosis of cerebral vessels should be differentiated from brain injury, nervous diseases.
- In the presence of plaques in the abdominal region, it is necessary to examine the organs of the digestive tract in more detail.
- In case of blockage of the vessels of the legs, a person may experience pain in the limbs. In this case, atherosclerosis should be distinguished from varicose veins.
What are the symptoms of cholesterol plaque?
In the early stages of the disease, there are usually no symptoms. With an increase in the size of a cholesterol plaque, a person experiences discomfort in the place where the diseased vessel is located. Discomfort often increases after intense physical work.
The following symptoms may indicate the presence of plaque in the body:
- Strong weakness.
- Visual disturbances.
- Problems with speech.
- Feeling of numbness in one arm or leg.
- Memory deterioration.
- Seizures.
In severe cases, a person may lose orientation in space. He has reduced concentration.
Neoplasms in the region of the thoracic aorta
Growths can form in the region of the thoracic aorta. In this case, a person has sharp pains in the region of the heart. They give to the shoulder blade, arm or shoulder. A person often has high blood pressure, severe shortness of breath appears. The face becomes pale.
Atherosclerotic plaques in the head region
With blockage of the arteries that feed the brain with blood, various neurological abnormalities appear. If the cholesterol plaque is located in the head area, the patient's performance is noticeably reduced, he becomes anxious and irritable. The patient's speech and hearing deteriorate. If these symptoms appear, seek medical attention immediately. Plaque in the area of the brain can cause a stroke.
Formation of neoplasms in the lower extremities
At an early stage, symptoms of the disease are usually absent. Then the person has pain in the muscles when walking, lameness. At a later stage of the disease, certain trophic disorders also appear. The patient begins to lose hair, muscle tissue atrophies. Some patients develop trophic ulcers.
Growths in the abdomen
With the formation of plaques in the abdominal aorta, a person has such characteristic symptoms:
- Swelling of the extremities.
- Discomfort in the digestive organs.
- Bloating.
- Problems with defecation.
- Feeling of numbness in the limbs.
Why are atherosclerotic plaques dangerous?
With the appearance of growths, a person's condition noticeably worsens. The danger of plaques is clearly shown in the table.
| Cardiac ischemia | Atherosclerosis can lead to the development of angina pectoris. When a plaque ruptures, a blood clot forms in the body, and death of myocardial tissue is observed. |
| brain damage | When plaques in the brain area rupture, a person can have a stroke. In some cases, it is preceded by a transient ischemic attack. |
| Decreased peripheral arteries in the legs | As a result, the patient's blood circulation in the lower extremities is disturbed. His wounds on his body are slowly healing, and there are unpleasant sensations in his legs. In severe cases, the patient develops gangrene, may require amputation of the legs. |
Medicines for atherosclerotic plaques
In the presence of cholesterol plaques, statins are actively used. Medicines reduce the amount of cholesterol, help speed up metabolic processes in the body.
These medicines include:
- "Lovastatin".
- "Atorvastatin".
In the complex therapy of the disease, other means are also used to help reduce cholesterol. These include drugs from the fibrate category: Clofibrate and Ciprofibrat.
In the treatment of atherosclerosis, nicotinic acid is also used. It is taken in short courses. When using nicotinic acid, the patient often has undesirable side effects:
- Dizziness.
- Redness of the face.
- Decreased blood pressure.
- Vitamin C.
- Askorutin.
The patient must not only take medications, but also follow a strict diet. It is recommended to exclude eggs, chocolate products, strong coffee, offal dishes and canned fish from the daily menu.
Surgical treatment of pathology
In difficult cases, when the plaque threatens the well-being of the patient, a surgical operation is performed. During stenting, a stent equipped with a balloon is inserted into the corresponding artery using a small tube. When it reaches the affected vessel, a clear image appears on the monitor of a special device. The balloon must be inflated to deploy the stent. The resulting design is left in the area of the vessel to expand its lumen.
The purpose of an operation such as coronary artery bypass grafting is to restore blood circulation. Shunts are blood vessels taken from another part of the body.
The benefits of herbal decoction against atherosclerotic plaques
In order to lower cholesterol levels, you can prepare such a medicinal decoction:
- You need to take 10 grams of periwinkle and caraway leaves.
- To these ingredients add 30 grams of hawthorn roots and 50 grams of mistletoe.
- All components of the drug are thoroughly mixed.
- They should be poured with 500 ml of boiling water.
- The mixture must be infused for at least 30 minutes.
- Then the broth is filtered with gauze wrapped in several layers.
The finished product is taken 200 ml twice a day. The duration of the treatment course depends on the severity of the disease.
Treatment of the disease with alcohol tincture of garlic
At the initial stage, atherosclerosis is treated with various alcohol tinctures. Garlic remedy is prepared according to the following scheme:
- 100 grams of garlic pour 150 ml of vodka. Before preparing the tincture, the vegetable must be thoroughly chopped.
- The mixture is tightly closed with a lid and placed for 14 days in a dry place protected from sunlight.
- After the specified time, the drug is filtered.
Where should you go if you suspect the presence of cholesterol plaques?
The patient should go to the clinic at the place of residence and make an appointment with a therapist. In the future, he may need to consult narrow specialists:
- The help of a neurologist is needed if atherosclerotic plaques are located in the brain area.
- Consultation with a cardiologist is necessary for patients who have a pronounced dysfunction of the cardiovascular system.
- With the appearance of pain or heaviness in the lower extremities, it is worth visiting a phlebologist. This specialist also carries out the treatment of trophic ulcers, often formed in atherosclerosis.
Generalized atherosclerosis (code according to the international classification ICD-10 - I70) is a pathology that affects several arteries at once. The disease develops due to a violation of lipid metabolism in the body. It causes different symptoms depending on the location of the lesion, often similar to other diseases. Therefore, pathology requires a thorough examination.
The main reason why generalized atherosclerosis occurs is an increased level of cholesterol in the blood. Lipids penetrate the walls of blood vessels, forming an atherosclerotic plaque there over time. The following factors can influence the development of pathology:
- hereditary predisposition. If there are people in the family who suffer from high levels of cholesterol in the blood, then the risk of atherosclerosis increases in other close relatives.
- Smoking and alcohol abuse. Cigarettes and alcohol contain many harmful substances that gradually destroy the vascular walls, making them more fragile.
- High blood pressure. When pressure increases in the body, the heart begins to push blood into the vessels with greater force. As a result, their walls are damaged, conditions are created for the development of atherosclerosis.
- Frequent stress and emotional overstrain. When a person is overexcited, the body produces adrenaline. This substance provokes an increase in the beating of the heart, an increase in pressure inside the vessels.
- Lack of physical activity. People who lead a sedentary lifestyle are often subject to the development of atherosclerosis, since excess fat is not burned, as is the case with movement. As a result, the amount of lipids is constantly increasing.
To prevent the development of atherosclerotic disease, all of these factors must be excluded from human life.
How does pathology develop?
Generalized atherosclerosis develops gradually, so its course was divided into several stages. There are 3 stages in total:
- First. Lipid spots form on the vascular wall. They appear on those areas that are damaged or have blood stasis. Under the influence of fats, the walls become loose, swell.
- Second. Where cholesterol accumulates, connective tissue appears, which leads to the formation of a full-fledged atherosclerotic plaque. It gradually increases in size, can block the lumen of blood vessels.
- Third. The plaques continue to grow, while they become denser, because calcium salts are deposited. At this stage, blood circulation in the body is disturbed, there is a high probability of blockage of the lumen.
If you do not take measures to eliminate plaques, complications such as stroke, heart attack, ischemia may develop.
Localization and symptoms
Generalized atherosclerosis can occur in different parts of the body. In most cases, it is detected in the vessels of the brain, cervical region, heart, and lower extremities. Several lesions appear at once in different places. The most dangerous is considered a disease that develops in the coronary arteries.
Symptoms of generalized atherosclerosis manifest differently depending on where the focus is located. Therefore, doctors distinguish several types of pathology, which are characterized by separate symptoms.
The first is atherosclerosis of the coronary arteries. In this case, the heart is affected, so the signs of the disease are associated with disturbances in its functioning. Patients complain of symptoms such as:
- Soreness in the chest.
- Disruptions in the heartbeat.
- Regular heart attacks.
Pathology can lead to the development of heart failure, heart attack, angina pectoris and even death.
Attention! The insidiousness of coronary artery disease lies in the fact that it proceeds for a long time without any signs. Often, doctors only after an autopsy or at an advanced stage recognize the pathology.
The second form of the disease is atherosclerosis of the brachiocephalic arteries. It poses no less danger to human life, as the brain is affected. Symptoms are in many ways similar to those of an ischemic stroke:
- Attacks of dizziness.
- Fainting.
- Loss of sensation in the lower and upper extremities.
- Decreased visual acuity.
- Nausea.
- Disorders of speech function.
Other neurological signs may also appear.
The next type of disease is atherosclerosis of the lower extremities. The main symptom of pathology is lameness. She does not worry all the time, but only during bouts of pain in the legs, which interfere with normal movement.
Complications
Generalized atherosclerosis, if left untreated, can cause serious complications. They arise due to the fact that the disease provokes a narrowing of the vascular lumens. This entails the development of ischemia, hypoxia, sclerosis.
With the growth of the plaque, blockage of the vessels occurs, which leads to circulatory disorders, acute vascular insufficiency, heart attack, stroke, aneurysm rupture and death.
Diagnostics
To detect vascular atherosclerosis, a comprehensive examination is carried out using laboratory and instrumental methods. These include:
- Blood test to determine the level of cholesterol.
- X-ray, which helps to identify the affected areas of the arteries.
- Angiography, which allows you to assess the state of blood vessels, blood flow.
- Ultrasound examination that visualizes the vessels, which helps to determine the location of the lesion.
If necessary, diagnostics is supplemented by other instrumental methods. Based on the data obtained during the examination, the doctor makes the final diagnosis and selects the most optimal therapy tactics.
Treatment
Treatment of generalized atherosclerosis is carried out using conservative and surgical methods. Patients are prescribed medications that lower cholesterol, strengthen the vascular walls, and normalize blood circulation. Statins, fibrates, bile acid sequestrants, nicotinic acid help with this.
Surgical intervention is performed in severe cases, when it is impossible to get rid of the pathology by a conservative method. To eliminate plaques, various operations are performed that help remove a lipid thrombus and expand the lumen of the vessel.
Diet food
The purpose of the diet is to normalize cholesterol levels. To achieve it, all foods containing a lot of fat are excluded from the diet: fatty meat, butter, smoked meats, canned food.
The menu includes more plant foods: vegetables, fruits, herbs, cereals. It is allowed to eat lean meats, fish. You can drink green tea, natural juices.
Prevention
To prevent the development of atherosclerosis, the following is recommended:
- Follow the rules of a healthy diet.
- To refuse from bad habits.
- Do sport.
- Monitor body weight.
- Timely treat pathologies that provoke problems with blood vessels.
- Avoid stress.
Generalized atherosclerosis is a serious disease that requires immediate treatment. Therefore, you can not ignore the elevated levels of cholesterol in the blood and postpone a visit to the doctor.
The following additional codes are used to indicate the presence or absence of gangrene, for optional use with the appropriate subcategories in I70.
- 0 no gangrene
- 1 With gangrene
Excludes: atherosclerosis of renal arterioles (I12.-)
Sclerosis (medial) Menckeberg
In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to apply 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. №170
The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.
With amendments and additions by WHO.
Processing and translation of changes © mkb-10.com
ICD-10: I70 - Atherosclerosis
Chain in classification:
4 I70 Atherosclerosis
Diagnosis with code I70 includes 5 clarifying diagnoses (ICD-10 subcategories):
The diagnosis also includes:
arteriolosclerosis arteriosclerosis arteriosclerotic vascular disease atheroma degeneration:
Vascular deforming or obliterating endarteritis senile:
The diagnosis does not include:
- cerebral (I67.2) coronary (I25.1) mesenteric (K55.1) pulmonary (I27.0)
Obliterating atherosclerosis of the vessels of the lower extremities (ICB code 10): treatment and prevention
In case of violation of blood flow in the arteries of the legs, accompanied by a narrowing of their lumen and a partial absence of vascular patency in the femoral and popliteal zones, obliterating atherosclerosis of the vessels of the lower extremities is diagnosed, which has an ICD10 code: 170.2.
Clogging of the lumen of the 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. There is stenosis of the arteries, and then they are completely closed.
Obliterating atherosclerosis of the vessels of the lower extremities ICD 10 classifies 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 noticed that in persons of pre-retirement age, the number of diagnosed cases of atherosclerosis of the lower extremities approaches 4%, and after 10 years - twice as often.
Causes
In order for an excess of cholesterol in the blood to cause such a serious disease as atherosclerosis of the vessels of the lower extremities, included in the international classification of ICD 10, there must be a combination of several factors affecting the structure of the arteries:
- Hereditary prerequisites (in persons who have relatives with atherosclerosis, there is a common gene that provokes this disease);
- Belonging to the male sex;
- Elderly age;
- hypertension;
- Diabetes;
- Smoking addiction;
- Wrong eating behavior;
- Obesity;
- Hypodynamia;
- Frequent physical activity;
- Hypothermia and frostbite of the legs;
- History of leg injury.
Stages and symptoms of the manifestation 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 leg arteries in the process and the overlap of their lumen.
There are 4 stages, differing in clinical manifestations:
- The first stage - the diagnosis is established only according to the results of laboratory tests of the blood composition, which detect an excess of cholesterol levels. There are no symptoms of the disease that are palpable by the patient.
- The second stage is characterized by the presence of the first noticeable signs of the disease, including numbness, soreness in the lower extremities, the appearance of muscle cramps and chilliness (due to the deterioration of the blood supply to these parts of the body).
- In the third stage, clinical symptoms are clearly manifested: 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. In a patient, lameness becomes permanent, persistent pain persists, leg muscles atrophy. The development of trophic ulcers and gangrene is likely, which can have fatal consequences up to the loss of a limb.
When identifying the described signs, if there are alarming phenomena, it is necessary to contact 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 is:
- Collecting an anamnesis;
- Assessment of clinical symptoms;
- Instrumental and hardware examination;
- Laboratory examination.
Laboratory tests include blood and urine tests.
Instrumental studies are Dopplerography to determine the characteristics of blood supply in the lower extremities, rheovasography, arteriography, angioscanning and thermography.
Attention is also paid to the differentiation of atherosclerosis (ICD) from thromboanginitis 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 state of the body and the stage of the disease.
Treatment can be conservative, with recreational measures, endovascular or surgical.
Treatment is designed to solve the primary problems:
- Reduce and facilitate the passage of pain in the patient;
- To promote endurance during everyday walking transitions;
- Stop the development of plaques in the vessels and prevent the formation of ulcers.
With conservative treatment, drugs are prescribed to restore blood supply to the legs; vitamin complexes; ointments containing antibiotics; local remedies 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 expansion of blood vessels using local anesthesia).
Surgical treatment comes to the rescue if nothing else has helped. Then doctors resort to thromboendarterectomy or bypass (organization of 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, and household health-improving activities, and natural remedies of traditional medicine.
- Treatment of concomitant diseases that complicate the treatment of atherosclerosis;
- smoking cessation;
- Rationing of physical activity;
- Protection of the lower extremities from hypothermia;
- Control of eating behavior in order to reduce cholesterol and lipids, adherence to dietary recommendations for weight loss and normalization.
Traditional medicine
- Infusions and decoctions of medicinal herbs: hawthorn, burdock, sweet clover, clover.
- The use of decoctions and tinctures for applying medicinal dressings soaked in decoction. For dressings and applications, decoctions of succession, plantain, St. John's wort, sage, chamomile, reindeer moss are used.
- To restore liver function, which is extremely important in the treatment of atherosclerosis, milk thistle or immortelle is used, separately from each other, taking their decoction inside.
- The use of artichoke as a plant with restorative properties, and garlic tincture.
Prevention
Like any type of atherosclerosis, atherosclerosis obliterans 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 a sufficient amount of physical activity, walks in the fresh air, the exclusion of alcoholic beverages and tobacco, a decrease in the proportion of sweet and flour products in the diet, the almost complete absence of canned food, fatty, fried, spicy foods as the rule of life.
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 your posture also provokes circulatory problems.
People with diabetes will help their leg skin, especially the feet, if they wipe it with a small amount of insulin.
What is vascular atherosclerosis and what is its ICD 10 code?
Atherosclerosis is a very common disease with almost two dozen varieties. In order to develop the most effective treatment methods, it is necessary to clearly distinguish between all these varieties and understand what each of them represents. It was for the convenience of accounting and classifying various diseases that doctors developed such a document as the ICD. Let's get to know him better.
What is the International Classification of Diseases?
The International Classification of Diseases is a document specially created for the statistical recording and classification of various diseases. The World Health Organization regularly reviews and updates it, and today physicians use the tenth edition of the ICD.
Diseases in this document are divided into classes, classes - into the so-called blocks of diagnoses, and those, in turn, into rubrics. Classes are formed on the basis of the nature of the disease itself (infectious disease, disorder of the nervous system, circulatory disorders). Blocks specify the disorder (for example, in the class of infectious diseases, blocks of bacterial, viral, fungal) are distinguished.
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 denote classes, numbers denote blocks and rubrics.
So, for example, the diagnosis "atherosclerosis of the arteries of the extremities" has the 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 at the location.
Varieties of the disease under the code I70
Atherosclerosis is a disease of the arteries that occurs due to a violation of 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 disturbed, and in the most severe cases, atherosclerotic plaques completely clog the artery, blocking the access of blood to organs and tissues.
The ICD distinguishes five varieties of this diagnosis, and each has an additional digital index:
- I70.0 - aortic atherosclerosis;
- I70.1 - atherosclerosis of the renal artery;
- I70.2 - atherosclerosis of the arteries of the extremities;
- I70.8 - atherosclerosis of other arteries (mesenteric and peripheral);
- I70.9 Generalized and unspecified atherosclerosis.
In terms of symptoms, it is similar to atherosclerosis - it also causes the formation of blood clots and blockage of blood vessels (obliteration). An important difference is that atherosclerosis is caused by a violation of protein metabolism, and endarteritis is an autoimmune disease. In addition, endarteritis can affect not only arteries, but also veins.
Let us consider in more detail the types of atherosclerosis of vessels and arteries.
I70.0 Aorta
The aorta is the largest blood vessel in the human body. That is why atherosclerosis of the aorta is especially difficult to recognize: it takes a long time for the plaque to grow to a size that can interfere with blood flow in this vessel. This disease develops over many years, and it can be recognized at the preclinical stage only with the help of special laboratory tests.
At the clinical stage, symptoms such as:
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 for a long time, usually against the background of hypertension.
Symptoms are problems with urination, abdominal pain, and sometimes nausea and vomiting. At the preclinical stage, the development of the disease is evidenced by a drop in the level of potassium in the blood.
I70.2 Arteries of limbs
When talking about this disease, as a rule, they 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 the blood flow in the limbs is disturbed, and the tissues begin to experience oxygen starvation. Even if the blood flow is not blocked completely, the risk of developing gangrene is high.
Symptoms of the disease are numbness of the extremities, pallor of the skin, convulsions, in the later stages - cyanosis and cyanosis.
The symptoms are almost identical, but the course of the disease and the methods of treatment are very different. In addition, endarteritis almost never affects the upper limbs.
I70.8 Other species
By "others" in the ICD is meant the mesenteric arteries responsible for the blood supply to the intestines and pancreas, the hepatic, gastric, splenic arteries, as well as two carotid - external and internal, which are responsible for the blood supply to the head.
The defeat of the latter is the most dangerous - a violation of the blood supply to the brain leads to a deterioration in memory, cognitive functions and even blindness, and with poor-quality treatment - to a stroke. In addition, unlike other types, the causes of atherosclerosis of the carotid arteries are still not clear. According to one hypothesis, this disease has an autoimmune character.
I70.9 Generalized and unspecified
Such a 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.
So, each type of disease has its own characteristics, which are important to consider in the diagnosis and treatment. The ICD is a convenient tool with which not only doctors, but also patients can quickly and accurately classify any violation of the body and plan further actions.
atherosclerosis mcb
International Classification of Diseases 10th Revision (ICD-10)
Class 9 Diseases of the circulatory system
I70-I79 Diseases of the arteries, arterioles and capillaries
I71 Aortic aneurysm and dissection
I72 Other forms of aneurysm
I73 Other peripheral vascular diseases
I74 Embolism and thrombosis of arteries
I77 Other disorders of arteries and arterioles
I78 Diseases of the capillaries
I79* Disorders of arteries, arterioles and capillaries in diseases classified elsewhere
Atherosclerosis of cerebral vessels (ICD-10 code: I67.2)
The zones of the second choice are the projection zones of the carotid arteries and vertebrobasilar arteries.
Rice. 84. Irradiation zones in the treatment of cerebral atherosclerosis. Symbols: pos. "1" - projection of the carotid vessels, pos. "2" - projection of vertebrobasilar vessels.
The projection zones of action on the carotid arteries (Fig. 84, item "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 efficiency in the treatment of the disease is achieved with a known localization of atherosclerotic plaques, which is established on the basis of instrumental studies. It is preferable to conduct duplex scanning of the arteries with the marking of the most affected parts of the artery.
Additionally, the projection zones of the aortic arch and pulmonary trunk, paravertebral zones C3-C7 are irradiated.
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 (ICB 10), obliterating atherosclerosis of the lower extremities is a disease of the leg arteries, characterized by their occlusive-stenotic lesion caused by excessive accumulation of cholesterol and lipids on the walls of blood vessels. Similar lipid and cholesterol accumulations, referred to in medicine as atherosclerotic plaques, as the disease progresses, can significantly increase in size and thereby provoke the appearance of not only a fairly pronounced narrowing (stenosis) of the arterial lumen, but also their complete overlap, which in most cases leads to lower limb ischemia.
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.
Disease prevalence
Obliterating atherosclerosis of the arteries of the lower extremities is one of the most common vascular diseases. According to the generalized data of various medical studies, with atherosclerosis, occlusive-stenotic lesions of the arteries of the legs are found in 20% of patients. It is noted that most often this disease occurs in persons belonging to a more mature age category. According to statistics, at the age of 45 to 55 years, this disease is detected only in 3-4% of people, while at an older age it is found already in 6-8% of the population. It is also important to note the fact that most often atherosclerotic diseases are diagnosed in the representatives of the male half, and in particular, in those men who have been abusing tobacco for a long period of time.
Causes of the disease
Medical specialists tend to believe that the main reason for the development of the disease in question lies in lipid metabolism disorders, namely, a significant increase in the level of lipophilic natural alcohol (cholesterol) in the blood. However, they also note that one accumulation of cholesterol in the vessels is not enough for the occurrence of atherosclerosis. In order for atherosclerosis obliterans to develop, in addition to rising 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 (from 45 years and older);
- gender (male);
- smoking (nicotine initiates the appearance of persistent vasospasm, which often contributes to the development of various pathological processes);
- various serious illnesses (diabetes mellitus, hypertension, etc.);
- malnutrition (overabundance of animal fats);
- lack of motor activity;
- overweight;
- excessive psycho-emotional and physical stress;
- frostbite of the extremities, as well as frequent hypothermia;
- previous leg injury.
Currently, representatives of medicine believe that in addition to all of the above conditional causes of atherosclerosis, there is also such a risk factor for the development of atherosclerotic diseases as a genetic predisposition. It has been scientifically proven that in some cases, an excessive increase in cholesterol in the blood of a person can be due precisely to his genetic heredity.
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 course of the disease itself and on the stage of its development. determined both by the degree of overlap of the artery and by the severity of the blood supply disturbances in the legs.
Modern medicine identifies four main stages in the 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 development of the disease, is diagnosed by passing a biochemical blood test, which reveals an elevated level of lipids);
- 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 there is severe pain in the legs, lameness can be observed, and thinning of the skin and the formation of small bleeding wounds and ulcers are also 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 experts warn that obliterating atherosclerosis of the vessels of the lower extremities is a serious and dangerous disease, the untimely treatment of which can lead to the appearance of gangrene of the leg, followed by its loss. And, therefore, in the event of any of the above signs, it is important to immediately consult a doctor in order to diagnose and cure the developed disease in time.
Diagnosis of the disease
The diagnosis of "atherosclerosis obliterans μb 10 code 170" is made on the basis of the collected history, clinical signs, as well as laboratory and instrumental research methods, including the delivery of certain tests (urine, blood) and the passage of a number of special medical examinations (rheovasography, dopplerography, thermometry, arteriography and functional load tests).
Treatment of the disease
After all the necessary diagnostic procedures have been carried out, followed by an accurate diagnosis, the doctor individually prescribes the most appropriate treatment for atherosclerosis obliterans to the patient. 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.
The relief of pathological processes in atherosclerotic diseases can include both a complex of therapeutic and recreational measures aimed at adjusting the daily lifestyle, as well as conservative, endovascular or surgical methods of treatment.
Treatment measures in such cases include:
- to give up smoking;
- hypocholesterol diet;
- 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 in a conservative way, 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 methods of treatment are considered to be quite effective non-surgical methods of restoring blood circulation through the vessels.
Surgical treatment is carried out only when a number of severe complications occur against the background of severe ischemia that is resistant to drug exposure. The main surgical methods for the treatment of atherosclerosis of the legs are: prosthetics (replacement of the affected part of the vessel with a prosthesis), shunting (restoration of blood flow using an artificial vessel), thrombendarterectomy (liquidation of the affected artery).
In cases where gangrene appears against the background of atherosclerotic disease, multiple necrosis of leg tissues is observed, and it is not possible to restore blood flow with the help of surgical intervention, amputation of the affected part of the leg is prescribed.
Progressive atherosclerosis is one of the main causes of disability due to amputation of the lower extremities, which means that for each patient suffering from this disease, it is important to start all the necessary medical procedures on time and strictly follow the basic medical prescriptions and recommendations.
Classification of atherosclerosis
Clinical classification of atherosclerosis
other vasomotor disorders
constitutional and hereditary disorders of lipid metabolism
endocrine diseases (DM, hypothyroidism, gonadal insufficiency)
atherosclerosis of the coronary arteries
atherosclerosis of the aorta and its branches
atherosclerosis of cerebral arteries
atherosclerosis of the renal arteries
atherosclerosis of the mesenteric arteries
atherosclerosis of peripheral arteries
III. Development periods:
b) atherosclerosis with a latent course
period of clinical manifestations
Stage I - ischemic
II stage - necrotic (thrombonecrotic)
III stage - fibrous
IV. Development phases
progression phase (active)
stabilization phase (inactive)
regression phase (remission)
V. Morphological stages
Recently, doctors are increasingly switching to the international classification of atherosclerosis according to ICD-10.
Classification of atherosclerosis (mkb - 10)
I 70. Atherosclerosis.
I 70.0. atherosclerosis of the aorta.
I 70.1. Atherosclerosis of the renal arteries.
I 70.2. Atherosclerosis of the arteries of the ending.
I 70.9. Generalized and unspecified atherosclerosis.
I 67.2. Atherosclerosis of cerebral vessels.
I 25.1. Atherosclerosis of the coronary vessels.
By 55.1. Atherosclerosis of the mesenteric vessels.
Clinical manifestations of atherosclerosis:
IHD (angina pectoris, myocardial infarction, cardiosclerosis, rhythm and conduction disturbances, acute or chronic heart failure);
Acute (strokes) or chronic disorders of cerebral circulation;
Arterial hypertension, primarily systolic, with damage to the aortic arch and its ascending part;
Thrombosis of mesenteric vessels, "abdominal toad";
Intermittent claudication, gangrene of the extremities;
AS of the renal arteries with the development of renovascular hypertension, with the formation of Goldblatt's kidney.
Clinical manifestations quite often do not correspond to morphological changes. In a pathological anatomical incision, a widespread and pronounced atherosclerotic vascular lesion may be an accidental finding. On the contrary, the clinic of severe ischemia of the organ may appear with moderate obliteration of the lumen of the vessel. Characteristic is the predominant lesion of certain arterial basins, on which the clinical picture of the disease primarily depends. Even within individual arterial basins, cellular lesions are characteristic - with the involvement of typical areas and the preservation of neighboring ones. Thus, among the vessels of the heart, the proximal anterior interventricular branch of the left coronary artery is most often affected. Also typical localization is the proximal part of the renal artery and the bifurcation of the carotid artery; and, for example, the internal thoracic artery is rarely affected. Atherosclerotic plaques often occur at arterial bifurcations, where blood flow is uneven. Nevertheless, always (with the exception of aortic AS) the clinic is predetermined by the manifestations and consequences of tissue or organ ischemia, which depend both on the degree of vasoconstriction and on the development of collaterals.
Atherosclerosis of the thoracic aorta
Aortalgia is a pressing pain behind the sternum that radiates to the shoulder, neck, back, and upper abdomen. The pain is not paroxysmal, prolonged. With a significant expansion of the aortic arch or aneurysm, there is difficulty in swallowing due to compression of the esophagus, hoarseness, dizziness, and convulsions with a sharp turn of the head. On auscultation - a shortened II tone with a metallic tint, systolic murmur, which increases when the arms are raised up and the head is tilted back (Sirotinin-Kukoverov symptom).
Atherosclerosis of the abdominal aorta
Pain in the abdomen of different localization, bloating, constipation as a manifestation of dysfunction of the abdominal organs due to narrowing of various arterial branches that extend from the aorta.
With atherosclerotic lesions of the aortic bifurcation, Leriche's syndrome develops - blockage of the aorta: intermittent claudication, coldness and numbness of the legs, atrophy of the muscles of the lower leg, impotence, ulcers and necrosis in the area of the fingers and feet with edema and hyperemia, lack of pulsation of the artery of the feet, popliteal artery, absence of pulsation of the aorta at the level of the navel, systolic murmur over the femoral artery in the inguinal fold. Above the abdominal aorta, a systolic murmur is heard in the midline above and at the level of the umbilicus.
Diagnosis of atherosclerosis, especially in its early stages, is a very serious problem. The diagnosis is based on the clinical manifestations of lesions of various organs, data from laboratory and instrumental studies, risk factors, etc.
AS diagnostics includes:
Questioning the patient and identifying clinical symptoms depending on the lesion and localization;
General examination of the patient: signs of aging, especially premature, significant hair growth in the auricles, a white border along the outer edge of the iris, xanthoma and xanthelasma, systolic murmur over the aorta, etc.
Determination of cholesterol and lipid spectrum of blood;
Angiographic examination (detection of vascular stenoses);
Doppler ultrasonography of blood vessels (detection of blood flow disorders);
Plain x-ray examination of the chest organs (detection of morphological changes in the heart and aorta);
Ultrasound examination of the heart and abdominal organs (detection of calcifications in the wall of blood vessels);
Magnetic resonance imaging of the brain.
Laboratory determination of blood lipid spectrum
Most often, only three of the components of the lipid spectrum are determined by the laboratory, namely: cholesterol, TG and HDL cholesterol. Prognostically significant LDL cholesterol in this situation is calculated using the Friedewald* formula:
In mmol/l: LDL cholesterol = total cholesterol - HDL cholesterol - (0.45 x triglyceride level);
in mg/dl: LDL cholesterol = total cholesterol - HDL cholesterol - (0.2 x triglyceride level).
* The calculation is only valid if the triglyceride concentrations are less than 4.5 mmol/L (400 mg/dL). An error in determining HDL-C or in determining TG in patients who have violated dietary recommendations before donating blood can steadily cause an error in calculating the most prognostic LDL-C!
To prevent the occurrence of an error in the "European recommendations for the prevention of cardiovascular diseases in clinical practice" it is recommended to determine non-HDL cholesterol on an empty stomach. This cholesterol is found in LDL, HDL, VLDL. Calculated by simply subtracting HDL cholesterol from total cholesterol, non-HDL cholesterol, unlike LDL cholesterol, does not require triglyceride levels to be less than 5 mmol/L. This indicator, like ups, is used to determine the degree of atherogenicity of lipoproteins in plasma and is more accessible than the determination of ups. Physicians who use non-HDL cholesterol levels to assess CVD risk in patients should consider the target level of therapy to be< 4 ммоль/л (150 мг/дл).
Determining the Risk of Total Cardiovascular Mortality Using the SCORE System
Patients with certain cardiovascular diseases represent a high risk group for developing cardiovascular complications. They need the most intensive lifestyle modification and, if necessary, the appointment of drug therapy. At the present stage, it is proposed to use a model for determining the overall risk based on the SСORE system (Systematic Coronary Risk Evaluation - Systematic Coronary Risk Evaluation), first introduced in the ESC recommendations in 2003. Practitioners should determine the overall risk for CVD in order to intensify preventive measures, t .e. if it is necessary to carry out dietary measures, individualize physical activity, prescribe drug therapy, adapt the dosage of drugs or their combinations to control risk factors.
Total CV risk can be easily calculated using a chart where physicians and patients are encouraged to use the SCORE system to determine total CV risk and ways to reduce it (both lifestyle modification and drug therapy) according to proven efficacy and safety in a multicenter study .
The SCORE system allows you to determine the total cardiovascular risk that is predicted by the age of 60. It may be especially important for prognosis in young patients with low absolute risk at age 20 and over, but already with an unfavorable risk factor profile that would place them in a higher risk category that will progress with age.
1. Patients with an established cardiovascular disease (patients with any clinical manifestations of coronary artery disease, with peripheral atherosclerosis, cerebral artery atherosclerosis, abdominal aortic aneurysm).
2. Asymptomatic patients who have:
Multiple risk factors that define a 10-year risk of 5% or more now and after age 60.
Significantly elevated levels of a single risk factor: total cholesterol > 8 mmol/l (320 mg/dl); LDL cholesterol > 6 mmol/L (240 mg/dL); BP > 180/110 mmHg Art.
Type 2 diabetes mellitus or type 1 diabetes with microalbuminuria.
3. The closest relatives of patients with early onset of CVD: in men under the age of 55 years, in women - 65 years.
1. Improving the quality of life of the patient.
2. Continuation of the patient's life expectancy.
The goal of treating the patient is achieved by solving the following tasks.
1. Decrease in the blood to normal elevated levels: cholesterol, cholesterol LDL and triglycerides.
2. An increase in the blood to normal levels of a reduced level of HDL cholesterol.
3. Prevention of the progression of various clinical forms of atherosclerosis (angina pectoris, etc.).
4. Prevention of complications of atherosclerosis (stroke, myocardial infarction, etc.).
Comprehensive treatment of patients with AS includes:
Lifestyle correction.
Following an appropriate diet.
Conducting drug therapy.
Drug treatment of hypercholesterolemia is started when there is no effect after an adequate 6-month hypocholesterolemic diet.
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Class 9 Diseases of the circulatory system
I70-I79 Diseases of the 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 Aortic aneurysm and dissection
- I71.0 Aortic dissection of any part
- I71.1 ruptured thoracic aortic aneurysm
- I71.2 Thoracic aortic aneurysm without mention of rupture
- I71.3 ruptured abdominal aortic aneurysm
- I71.4 Abdominal aortic aneurysm without mention of rupture
- I71.5 Ruptured thoracic and abdominal aortic aneurysm
- I71.6 Thoracic and abdominal aortic aneurysm without mention of rupture
- I71.8 Aortic aneurysm, unspecified location, ruptured
- I71.9 Aortic aneurysm of unspecified location without mention of rupture
I72 Other forms of aneurysm
- I72.0 carotid aneurysm
- I72.1 Aneurysm of the artery of the upper extremities
- I72.2 Renal artery aneurysm
- I72.3 Aneurysm of the iliac artery
- 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 Thromboangiitis 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 arteries of the lower extremities
- I74.4 Embolism and thrombosis of limb arteries, 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 disorders of arteries and arterioles
- I77.0 Acquired arteriovenous fistula
- I77.1 Narrowing of the arteries
- I77.2 Rupture of an artery
- I77.3 Muscular and connective tissue dysplasia of the arteries
- I77.4 Syndrome of compression of the celiac trunk of the abdominal aorta
- I77.5 artery necrosis
- I77.6 Arteritis, unspecified
- I77.8 Other specified changes in arteries and arterioles
- I77.9 Modification of arteries and arterioles, unspecified
I78 Diseases of the capillaries
- I78.0 Hereditary hemorrhagic telangiectasia
- I78.1 Nevus non-tumor
- I78.8 Other capillary diseases
- I78.9 Disease of capillaries, unspecified
I79* Disorders 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 disorders of arteries, arterioles and capillaries in diseases classified elsewhere
Atherosclerosis of cerebral vessels (ICD-10 code: I67.2)
The zones of the second choice are the projection zones of the carotid arteries and vertebrobasilar arteries.
Rice. 84. Irradiation zones in the treatment of cerebral atherosclerosis. Symbols: pos. "1" - projection of the carotid vessels, pos. "2" - the projection of the vertebrobasilar vessels.
The projection zones of action on the carotid arteries (Fig. 84, item "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 efficiency in the treatment of the disease is achieved with a known localization of atherosclerotic plaques, which is established on the basis of instrumental studies. It is preferable to conduct duplex scanning of the arteries with the marking of the most affected parts of the artery.
Additionally, the projection zones of the aortic arch and pulmonary trunk, paravertebral zones C3-C7 are irradiated.
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 (ICB 10), obliterating atherosclerosis of the lower extremities is a disease of the leg arteries, characterized by their occlusive-stenotic lesion caused by excessive accumulation of cholesterol and lipids on the walls of blood vessels. Similar lipid and cholesterol accumulations, referred to in medicine as atherosclerotic plaques, as the disease progresses, can significantly increase in size and thereby provoke the appearance of not only a fairly pronounced narrowing (stenosis) of the arterial lumen, but also their complete overlap, which in most cases leads to lower limb ischemia.
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.
Disease prevalence
Obliterating atherosclerosis of the arteries of the lower extremities is one of the most common vascular diseases. According to the generalized data of various medical studies, with atherosclerosis, occlusive-stenotic lesions of the arteries of the legs are found in 20% of patients. It is noted that most often this disease occurs in persons belonging to a more mature age category. According to statistics, at the age of 45 to 55 years, this disease is detected only in 3-4% of people, while at an older age it is found already in 6-8% of the population. It is also important to note the fact that most often atherosclerotic diseases are diagnosed in the representatives of the male half, and in particular, in those men who have been abusing tobacco for a long period of time.
Causes of the disease
Medical specialists tend to believe that the main reason for the development of the disease in question lies in lipid metabolism disorders, namely, a significant increase in the level of lipophilic natural alcohol (cholesterol) in the blood. However, they also note that one accumulation of cholesterol in the vessels is not enough for the occurrence of atherosclerosis. In order for atherosclerosis obliterans to develop, in addition to rising 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 (from 45 years and older);
- gender (male);
- smoking (nicotine initiates the appearance of persistent vasospasm, which often contributes to the development of various pathological processes);
- various serious illnesses (diabetes mellitus, hypertension, etc.);
- malnutrition (overabundance of animal fats);
- lack of motor activity;
- overweight;
- excessive psycho-emotional and physical stress;
- frostbite of the extremities, as well as frequent hypothermia;
- previous leg injury.
Currently, representatives of medicine believe that in addition to all of the above conditional causes of atherosclerosis, there is also such a risk factor for the development of atherosclerotic diseases as a genetic predisposition. It has been scientifically proven that in some cases, an excessive increase in cholesterol in the blood of a person can be due precisely to his genetic heredity.
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 course of the disease itself and on the stage of its development. determined both by the degree of overlap of the artery and by the severity of the blood supply disturbances in the legs.
Modern medicine identifies four main stages in the 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 development of the disease, is diagnosed by passing a biochemical blood test, which reveals an elevated level of lipids);
- 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 there is severe pain in the legs, lameness can be observed, and thinning of the skin and the formation of small bleeding wounds and ulcers are also 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 experts warn that obliterating atherosclerosis of the vessels of the lower extremities is a serious and dangerous disease, the untimely treatment of which can lead to the appearance of gangrene of the leg, followed by its loss. And, therefore, in the event of any of the above signs, it is important to immediately consult a doctor in order to diagnose and cure the developed disease in time.
Diagnosis of the disease
The diagnosis of "atherosclerosis obliterans μb 10 code 170" is made on the basis of the collected history, clinical signs, as well as laboratory and instrumental research methods, including the delivery of certain tests (urine, blood) and the passage of a number of special medical examinations (rheovasography, dopplerography, thermometry, arteriography and functional load tests).
Treatment of the disease
After all the necessary diagnostic procedures have been carried out, followed by an accurate diagnosis, the doctor individually prescribes the most appropriate treatment for atherosclerosis obliterans to the patient. 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.
The relief of pathological processes in atherosclerotic diseases can include both a complex of therapeutic and recreational measures aimed at adjusting the daily lifestyle, as well as conservative, endovascular or surgical methods of treatment.
Treatment measures in such cases include:
- to give up smoking;
- hypocholesterol diet;
- 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 in a conservative way, 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 methods of treatment are considered to be quite effective non-surgical methods of restoring blood circulation through the vessels.
Surgical treatment is carried out only when a number of severe complications occur against the background of severe ischemia that is resistant to drug exposure. The main surgical methods for the treatment of atherosclerosis of the legs are: prosthetics (replacement of the affected part of the vessel with a prosthesis), shunting (restoration of blood flow using an artificial vessel), thrombendarterectomy (liquidation of the affected artery).
In cases where gangrene appears against the background of atherosclerotic disease, multiple necrosis of leg tissues is observed, and it is not possible to restore blood flow with the help of surgical intervention, amputation of the affected part of the leg is prescribed.
Progressive atherosclerosis is one of the main causes of disability due to amputation of the lower extremities, which means that for each patient suffering from this disease, it is important to start all the necessary medical procedures on time and strictly follow the basic medical prescriptions and recommendations.
