Common atherosclerosis ICD 10. Atherosclerosis of the lower extremities - a complete description of the disease and treatment methods

The structure of the penis contains a huge number of blood vessels. Their function is to ensure that the organ is filled with blood and brings it into a state of erection during sexual arousal.

In case of disturbances in the functioning of the circulatory system of the male genital organ, a decrease in potency is observed. One of the reasons for the appearance of malfunctions in the vascular system of the organ is atherosclerosis of the penis.

Atherosclerosis of the capillaries of the penis occurs under the negative influence of various factors.

The male genital organ is supplied with blood through 3 arteries:

• Bulbourethral - provides blood supply to the bulb and corpus spongiosum.
• The cavernous artery provides nutrition to the corpus cavernosum and reaches its base.
• The dorsal artery is responsible for the swelling of the corpora cavernosa as they fill with blood during erection.

The outflow of blood from the penis is ensured by the venous vascular system. It consists of 3 veins - superficial, middle and deep. If malfunctions occur in at least one of the systems, there is a risk of decreased potency and the development of pathologies.

Mechanisms of pathology formation

Symptoms of the development of atherosclerosis of the vessels of the penis occur immediately after the forming cholesterol plaque aggravates blood circulation. The formation of cholesterol deposits leads to a decrease in blood flow to the penile tissue. Most often, the first manifestations of the development of pathology are minor problems with potency.

Men perceive this reaction of the body as a response to frequent exposure to stressful situations or to the occurrence of minor health problems.

Pathology is most often recorded at that stage of its progression when the cholesterol plaque reaches a significant size. At this stage, treatment of the disease is extremely difficult and in many cases the use of surgical treatment methods is required.

The main danger associated with the development of atherosclerosis of the vascular system of the penis is due to the fact that, under the influence of pathology, the blood supply processes in the internal organs are destabilized.

Impaired blood supply leads to insufficient supply to organ cells nutrients and oxygen.

Due to insufficient blood supply, the patient develops the following abnormalities:

1. erectile dysfunction manifests itself in varying degrees of severity;
2. formation and development of prostate adenoma is observed;
3. The presence of stable impotence is revealed, smoothly turning into chronic.

When a pathology is detected on initial stage it is quite easy to develop drug treatment. The use of specialized pharmaceuticals can significantly improve the condition of the vascular system. During therapy, cholesterol deposits disappear and blood circulation improves.

The presence of this disease in a patient may indicate the occurrence of disturbances in the metabolic processes that ensure fat metabolism.

Treatment of atherosclerosis of penile vessels

Sugar level

If the disease is detected in the early stages and the disease progresses, treatment of the disease is carried out with the help of drug therapy. For this purpose, medications are used to ensure the normalization of metabolic processes in the body.

Thanks to the use of such drugs, symptoms characteristic of the disease are eliminated, and blood pressure is normalized.

During therapy, atherosclerotic plaques are reabsorbed.

If the disease is detected in an advanced form, surgical methods are used to treat the disease.

Surgery is required if the patient is diagnosed with arterial stenosis.

If stenosis is detected, treatment is carried out by removing the cholesterol deposits or removing the entire affected area of ​​the vessel.

The purpose of the surgical intervention is to improve the blood supply to the male genital organ. This operation is used only in extreme cases and if the patient has appropriate indications.

The development of pathology is due to metabolic disorders. Therefore, if the patient does not change his lifestyle and does not follow the diet recommended for him by the doctor, atherosclerotic disorders will remind themselves again.

Impotence developing in a man in the presence of atherosclerosis requires an integrated approach to treatment.

If there is venous insufficiency, the doctor recommends taking medicines, which help increase the elasticity of the walls of venous vessels.

When carrying out complex treatment, several groups of drugs are used:

• Medicines that combat the symptoms of pathology and increased blood pressure.
• Means that ensure the normalization of metabolic processes.
• Drugs whose action is aimed at thinning the blood and reducing the rate of blood clotting.
• Medicines that loosen cholesterol deposits and optimize the removal of cholesterol from the body.

An integrated approach to therapy allows you to normalize the body’s functioning in a fairly short period of time.

Folk remedies for the treatment of atherosclerosis of the penis

The disease can be combated using methods traditional medicine.

To obtain optimal results from the therapy used, it is recommended to combine the use of traditional medicine with classical drug treatment.

The use of traditional methods has a significant advantage - their use is absolutely harmless to the patient’s health.

After appropriate consultation with your doctor, you can use traditional recipes. and help normalize blood flow:

1. Taking a nettle bath. To prepare it, you need to take fresh nettle leaves, put them in the bathroom and pour boiling water over them. 30 minutes after the start of preparation, the resulting mixture is diluted with cold water. The duration of the procedure should be at least 30 minutes. The use of such a bath increases the tone of the vascular wall. It is recommended to use the procedures for one month.
2. Tincture of Sophora japonica. To prepare the product you will need 100 grams of plant pods. The pods are crushed and 500 ml of vodka is poured. The resulting mixture is placed in a cold place for three weeks. After the infusion period ends, the tincture is ready for use. You need to drink 10 ml three times a day before meals. The duration of the course of therapy is at least three months.
3. An infusion made from red clover is highly effective against atherosclerosis. To prepare the product, take 40 grams of flowers and add 500 ml of vodka. The drug should be infused for 14 days. After this period ends, the resulting mixture is filtered. The resulting tincture is consumed 20 ml before meals. The drug is taken once a day. The duration of the therapeutic effect is three months. After such a course, you should take a break for two weeks and upon completion of the break it is recommended to repeat the course of treatment.

Simultaneously with the use of traditional medicine, it is necessary to change lifestyle and eating habits. This approach will speed up the achievement of positive results from therapy.

Consequences of pathology development and preventive measures

Atherosclerotic changes in the vascular system of the penis are accompanied by a decrease in sexual desire and the occurrence of anatomical changes, which over time become visible to the naked eye.

The patient experiences a decrease in potency due to poor blood supply to the organ. In addition, there are problems in the functioning of the testicles associated with insufficient blood supply to the gonads. A progressive decrease in their size is revealed.

Quite often there are curvatures of the penis, which are formed as a result of reduction or enlargement of veins.

Damage to the arteries supplying the genital organ with blood is completely reparable, however, for this purpose, you should follow all the recommendations of the attending physician, both during the treatment and after it.

To prevent recurrence of the disease you should:

• be regularly examined by a urologist and andrologist;
• observe special;
• regularly attend exercise therapy classes;
• increase the consumption of foods with a high content of vitamin C or start taking vitamin complexes containing an increased concentration of this component.

If the patient has a genetic predisposition to the development of pathology, it is recommended to visit a doctor for examination and consultation at least once every 8-9 months.

Compliance with preventive measures allows you to maintain health and avoid the onset of illness in almost 100% of cases.

In the video in this article, Dr. Bockeria will talk about atherosclerosis.

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

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

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

Atherosclerosis according to ICD-10

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

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

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

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

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

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

ICD-10 I70.0 Aorta

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

At the clinical stage, symptoms such as:

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

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

I70.1 Renal artery

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

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

ICD-10 I70.2 Arteries of the extremities

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

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

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

Important: Vascular atherosclerosis should not be confused with endarteritis.

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

I70.8 Other species

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

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

I70.9 Generalized and unspecified atherosclerosis

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

Atherosclerosis of peripheral arteries- disease of peripheral arteries with a chronic course. A segmental obstruction to blood flow or narrowing of the lumen of the main arteries is formed, causing a pronounced decrease or cessation of blood flow, usually in the arteries of the lower extremities. As a result, ischemia occurs with the onset of pain, and with circulatory decompensation - trophic ulcers and gangrene. At the same time, the mesenteric and celiac arteries may be involved in the process.

Code according to the international classification of diseases ICD-10:

• I70.2
• I70.8
• I70.9

Frequency increases with age (in parallel with the incidence of atherosclerosis). Predominant age- elderly. Predominant gender- male (2:1).

Causes

Risk factors. Smoking. SD. Hyperlipidemia. Arterial hypertension. Excessive physical stress.

Pathomorphology. Thrombi in the lumen of the artery. Calcified inclusions in the middle shell of an occluded vessel, atheromatous plaques of the inner shell.

Symptoms (signs)

Clinical picture. Intermittent claudication. Systolic murmur over the affected arteries. Auscultation points.. Behind the angle of the lower jaw (bifurcation of the carotid artery and the initial section of the internal carotid artery).. Place of attachment of the sternocleidomastoid muscle to the clavicle (initial segment of the common carotid artery, subclavian artery).. Under the xiphoid process (abdominal aorta, celiac trunk) .. From the navel towards the points between the inner and middle thirds of the inguinal ligament (right and left iliac arteries).. Inguinal fold (femoral artery).. Popliteal fossa (popliteal artery). Points of palpation of the arteries of the lower limb.. Femoral artery - the middle of the inguinal ligament.. Popliteal artery - popliteal fossa.. Posterior tibial artery - behind the medial malleolus.. Dorsal artery of the foot - from the middle of the intermalleolar line to the first interdigital space. Classification of obliterating atherosclerosis. Stage I - pain in the calf muscles appears when walking calmly over a distance of 1 km. IIA - the patient can walk more than 200 m before the onset of pain. IIB - the patient can walk less than 200 m at a normal pace before the onset of pain. III - pain occurs at rest and when walking at a distance of up to 25 m. IV - ulcerative-necrotic changes in the lower extremities.

Diagnostics

Laboratory research. Bleeding time. PTI. Plasma glucose. Cholesterol. Fibrinogen. Fibrinogen B.

Special studies. Non-invasive.. Segmental measurement of blood pressure (reduced distal to arterial stenosis or occlusion) at different levels of the arm or leg before and after physical activity.. Ankle-brachial index (ABI) - the ratio of blood pressure in the ankle joint to blood pressure in the brachial artery... Patients with complaints of intermittent claudication usually have a LPP below 0.8 (normally 1.0)... In patients with pain at rest, the LPP is less than 0.5. When the index is below 0.4, necrosis of the tissues of the limb is possible... The value of DILI is falsely elevated due to arterial calcification (usually with a combination of atherosclerosis and diabetes).. Rheovasography.. Doppler duplex study. Invasive methods... Intravenous angiography with digital image processing.. Arterial angiography with digital processing. Conventional arteriography is the standard method for assessing vascular diseases. The contrast agent is injected into the arterial bed either by puncture of the abdominal aorta in the lumbar region (translumbar aortography), or by puncture of the femoral artery with a special probe advanced to the required distance. Sequentially, as the contrast agent descends to the periphery, a series of x-rays are taken.

Treatment

TREATMENT

Mode. In stage I and stage IIA the mode is outpatient. In more severe stages - hospitalization for surgical treatment. Physical activity: Avoid activities that cause pain.

Diet No. 10c, which helps reduce cholesterol in the blood serum (see Atherosclerosis); for obesity - normalization of body weight.

Surgery

Indications for surgical treatment are IIB (with rapid progression), III-IV stages of the disease.

Minimally invasive methods. Intravascular dilatation of the stenotic area through inflation of the balloon catheter results in crushing of atherosclerotic plaques. Stenting is the introduction of self-expanding stents into the narrowing area, often containing drugs that help dissolve the atherosclerotic plaque. Dilatation is carried out by an angiologist during angiography. The angiographic catheter is replaced with a balloon one and, under the control of an electron-optical converter, is brought to the area of ​​stenosis. Then the balloon is inflated with oxygen or an inert gas under a pressure of 4-8 atm. Arterial dilatation can be complicated by distal embolism and rupture of the vessel in the area of ​​dilatation, which occurs in 3-5% of cases. The duration of vessel patency after balloon dilatation depends on the location of the lesion. Dilatation of the iliac and femoral arteries gives good results, but the patency of small arteries is restored for a much shorter period.

Open types of surgical interventions.. Bypass operations: aorto-femoral bypass with a synthetic prosthesis, femoral-popliteal and femoral-tibial bypass with an autovenous vein... The patency of the autovenous bypass for 5 years is maintained in 65-80% of patients, the limb can be saved in 90% of cases ... The main cause of death after surgery is MI. Therefore, before surgery, patients should identify hidden coronary insufficiency and treat coronary artery disease. Endarterectomy - opening the lumen and removing the atheromatous plaque along with the inner membrane. Used only for local lesions of the aorta or common iliac arteries... Lumbar sympathectomy is indicated for patients with diseases of the arteries of the lower extremities that are not amenable to reconstruction... Good results can be achieved in patients with moderate rest pain, small superficial skin ulcers or in patients with DILI more than 0.3 ... This procedure is rarely indicated for patients with diabetes, because many of them undergo autosympathectomy. Amputation in some cases can not only save life, but also contribute to the rehabilitation of the patient. Approximately 50% of amputations occur in cases complicated by diabetes. Indications for amputation: ... Impossibility of reconstructing the affected vessels... Persistence of critical ischemia after restoration of the main blood flow... Gangrene of the foot... Sepsis.

Drug therapy. Pentoxifylline 400 mg 3 times a day. It should be used with caution in case of labile blood pressure, heart failure, sclerosis of the coronary vessels, impaired liver and kidney function, in combination with antihypertensive and antidiabetic drugs. Acetylsalicylic acid. Lipid-lowering drugs (lovastatin, lipostabil). Ganglion blockers (benzohexonium, dimecolium iodide). Andekalin. Xanthinol nicotinate 0.5-1 g 2-3 times a day after meals. Contraindicated in cases of bleeding, myocardial infarction, severe heart failure, peptic ulcer in the acute stage. It should be used with caution in case of labile blood pressure, pregnancy, and in combination with antihypertensive drugs. Nicotinic acid, nicoshpan. Antihypoxants (vitamin E). B vitamins, ascorbic acid. Solcoseryl.

Physiotherapy. Diadynamic currents, diathermy of the lumbar region, barotherapy. Balneotherapy: hydrogen sulfide baths (Pyatigorsk, Sochi-Matsesta).

Complications. Trophic ulcers. Vessel thrombosis. Gangrene.

Course and prognosis. The course varies from slowly progressing with minor symptoms to rapid deterioration leading to the need for surgical intervention. The prognosis is relatively favorable. Only in 10% of patients within 10 years the disease progresses to the degree of severe ischemia of the limb. The survival rate of such patients is quite high (5-year - 73%, 10-year - 38%).. The most common reason death - atherosclerotic damage to the coronary arteries of the heart.

Synonyms. Atherosclerosis of the arteries of the extremities. Obliterating atherosclerosis

Reduction. ALI—ankle-brachial index.

ICD-10. I70.2 Atherosclerosis of the arteries of the extremities. I70.8 Atherosclerosis of other arteries. I70.9 Generalized and unspecified atherosclerosis

Clinical classification of atherosclerosis

A. Hemodynamic:

hypertonic disease

vasospasm

other vasomotor disorders

B. Metabolic:

constitutional and hereditary disorders of lipid metabolism

nutritional disorders

endocrine diseases (DM, hypothyroidism, gonadal insufficiency)

B. Mixed.

II. Localization:

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:

initial (preclinical)

a) presclerosis

b) atherosclerosis with a latent course

period of clinical manifestations

Stage I - ischemic

Stage II - necrotic (thrombonecrotic)

Stage III - fibrous

IV. Phases of development

progression phase (active)

stabilization phase (inactive)

regression phase (remission)

V. Morphological stages

Lipoidosis

Liposclerosis

Atheromatosis

Calcinosis

Recently, doctors are increasingly switching to the international classification of atherosclerosis according to ICD-10.

Classification of atherosclerosis (ICD - 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 terminal arteries.

I 70.9. Generalized and unspecified atherosclerosis.

I 67.2. Atherosclerosis of cerebral vessels.

I 25.1. Atherosclerosis of the coronary vessels.

To 55.1. Atherosclerosis of mesenteric vessels.

Clinical manifestations of atherosclerosis:

IHD (angina pectoris, myocardial infarction, cardiosclerosis, rhythm and conduction disturbances, acute or chronic heart failure);

Acute (stroke) or chronic cerebrovascular accidents;

Arterial hypertension, primarily systolic, with damage to the aortic arch and its ascending part;

Thrombosis of mesenteric vessels, "abdominal toad";

Aortic aneurysm;

Intermittent claudication, gangrene of the extremities;

AS of the renal arteries with the development of renovascular hypertension, with the formation of the Goldblatt kidney.

Clinical manifestations quite often do not correspond to morphological changes. On pathoanatomical section, widespread and severe atherosclerotic vascular lesions may be an incidental finding. On the contrary, the clinical picture of severe organ ischemia may appear with moderate obliteration of the lumen of the vessel. Characteristic is the predominant damage to certain arterial basins, on which the clinical picture of the disease primarily depends. Even within individual arterial basins there are characteristic cellular lesions - with the involvement of typical areas and preservation of neighboring ones. Thus, among the vessels of the heart, the proximal part of the anterior interventricular branch of the left coronary artery is most often affected. Also typical locations are the proximal renal artery and the bifurcation of the carotid artery; and, for example, the internal mammary artery is rarely affected. Atherosclerotic plaques often occur at arterial bifurcations—where blood flow is uneven. Nevertheless, the clinical picture is always (with the exception of aortic AS) determined by the manifestations and consequences of tissue or organ ischemia, which depend on both the degree of vasoconstriction and 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, long-lasting. With a significant expansion of the aortic arch or an aneurysm, difficulty swallowing occurs due to compression of the esophagus, hoarseness of the voice, possible dizziness, and convulsions when turning the head sharply. On auscultation - a shortened 2nd tone with a metallic tint, a systolic murmur, which intensifies when raising the arms up and tilting the head back (Sirotinin-Kukoverov symptom).

Atherosclerosis of the abdominal aorta

Abdominal pain of various localizations, bloating, constipation as a manifestation of dysfunction of the abdominal organs due to narrowing of various arterial branches that arise from the aorta.

With atherosclerotic lesions of the aortic bifurcation, Leriche syndrome develops - blockage of the aorta: intermittent claudication, coldness and numbness of the legs, atrophy of the leg muscles, impotence, ulcers and necrosis in the area of ​​​​the fingers and feet with swelling and hyperemia, absence of pulsation of the artery of the feet, popliteal artery, absence of pulsation of the aorta at the level of the navel, systolic murmur above the femoral artery in the inguinal fold. A systolic murmur is heard over the abdominal aorta in the midline above and at the level of the umbilicus.

Diagnosis of atherosclerosis:

Diagnosis of atherosclerosis, especially in its early stages, is a very serious problem. The diagnosis is based on clinical manifestations of lesions of various organs, data from laboratory and instrumental studies, risk factors, etc.

Diagnosis of AS includes:

Questioning the patient and identifying clinical symptoms depending on the lesion and location;

General examination of the patient: signs of aging, especially premature aging, significant hair growth in the ears, a white border along the outer edge of the iris, xanthoma and xanthelasma, systolic murmur over the aorta, etc.

Determination of cholesterol levels and blood lipid spectrum;

Angiographic examination (detection of vascular stenoses);

Doppler ultrasonography of blood vessels (detection of blood flow disorders);

General 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 walls 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 in 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 valid only if triglyceride concentrations are less than 4.5 mmol/L (400 mg/dL). An error in determining HDL cholesterol or in determining TG in patients who violated dietary recommendations before donating blood can inevitably lead to an error in calculating the most prognostically significant LDL cholesterol!

To prevent errors, the European Guidelines for the Prevention of Cardiovascular Diseases in Clinical Practice recommend determining non-HDL cholesterol in the fasting state. This cholesterol is found in LDL, LDLP, and 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 apov, is used to determine the degree of atherogenicity of lipoproteins in plasma and is more accessible than the determination of apov. Clinicians who use non-HDL cholesterol to assess patients' CVD risk should consider the target level of therapy to be equal to< 4 ммоль/л (150 мг/дл).

Determining the risk of total cardiovascular mortality using the SCORE system

Patients with certain cardiovascular diseases are at high risk of developing cardiovascular complications. They require the most intensive lifestyle modification and, if necessary, drug therapy. At the present stage, it is proposed to use a model for determining the overall risk based on the system SCORE(Systematic Coronary Risk Evaluation), first presented in the ESC recommendations in 2003. Practitioners should determine the overall risk for CVD in order to intensify preventive measures, i.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 cardiovascular risk can be easily calculated using a chart where doctors and patients are suggested to use the system SCORE to determine overall cardiovascular 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 overall cardiovascular risk, which is predicted by age 60. It may be particularly important for prognosis in young patients with a low absolute risk at age 20 years, but with an unfavorable risk factor profile that would place them in a higher risk category that will progress with increasing age.

1. Patients with established cardiovascular disease(patients with any clinical manifestations of coronary artery disease, with peripheral atherosclerosis, cerebral artery atherosclerosis, abdominal aortic aneurysm).

2. Asymptomatic patients which have:

Multiple risk factors that determine a 10-year risk of 5% or greater now and after age 60.

Significantly elevated levels single risk factor: total cholesterol > 8 mmol/l (320 mg/dl); LDL cholesterol > 6 mmol/l (240 mg/dl); Blood pressure > 180/110 mm Hg. Art.

Diabetes mellitus type 2 or diabetes mellitus type 1 with microalbuminuria.

3. Close relatives of patients with early onset CVD: for men under 55 years of age, for women - 65 years.

Treatment of atherosclerosis:

Goal of treatment:

1. Improving the patient’s quality of life.

2. Extension of the patient's life expectancy.

The goal of treating a patient is achieved by solving the following tasks.

1. Decrease in blood to normal levels of increased levels: cholesterol, LDL cholesterol and TG.

2. An increase in the blood level of HDL cholesterol to normal levels.

3. Prevention of progression of various clinical forms of atherosclerosis (angina, etc.).

4. Prevention of complications of atherosclerosis (stroke, myocardial infarction, etc.).

Comprehensive treatment of patients with AS includes:

Lifestyle correction.

Maintaining an appropriate diet.

Carrying out drug therapy.

Phytotherapy.

Efferent therapy.

Hepatotropic therapy.

Spa treatment.

Drug treatment of hypercholesterolemia begins when there is no effect after an adequate 6-month hypocholesterolemic diet.

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

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

Group of diseases associated with atherosclerotic lesions

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

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

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

Vascular complications of the legs, systematized in the International Classification

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

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

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

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

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

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

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

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