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 the overall cardiovascular risk and ways to reduce it (both lifestyle modification and drug therapy) according to the effectiveness and safety proven 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 of a 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.
Generalized atherosclerosis (code according to the international classification ICD-10 - I70) is a pathology that affects several arteries at once. The disease develops as a result of 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 increased cholesterol levels in the blood. Lipids penetrate the walls of blood vessels, eventually forming an atherosclerotic plaque there. 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 wall and make 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, creating conditions for the development of atherosclerosis.
- Frequent stress and emotional overstrain. When a person is overexcited, the body produces adrenaline. This substance provokes increased heartbeat and increased pressure inside the blood vessels.
- Lack of physical activity. People who lead a sedentary lifestyle are often susceptible to the development of atherosclerosis, since excess fat is not burned, as happens when moving. As a result, the amount of lipids constantly increases.
To prevent the development of atherosclerotic disease, all of these factors must be excluded from a person’s life.
How does pathology develop?
Generalized atherosclerosis develops gradually, so its course is divided into several stages. There are 3 stages in total:
- First. Lipid stains form on the vascular wall. They appear in areas that are damaged or have blood stagnation. Under the influence of fats, the walls become loose and swell.
- Second. Where cholesterol accumulates, connective tissue appears, which leads to the formation of a full-fledged atherosclerotic plaque. It gradually increases in size and can block the lumen of blood vessels.
- Third. The plaques continue to grow, and they become denser because calcium salts are deposited. At this stage, blood circulation in the body is disrupted, and there is a high probability of blockage of the lumen.
If measures are not taken to eliminate plaques, complications such as stroke, heart attack, and 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 spine, heart, and lower extremities. Several lesions appear in different places at once. The most dangerous disease is considered to develop in the coronary arteries.
Symptoms of generalized atherosclerosis manifest differently depending on where the lesion 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:
- Pain in the chest.
- Heartbeat disturbances.
- Regular heart attacks.
The pathology can lead to the development of heart failure, heart attack, angina pectoris and even death.
Attention! The insidiousness of coronary artery disease is that it occurs for a long time without any symptoms. Often doctors only recognize the pathology after an autopsy or at an advanced stage.
The second form of the disease is atherosclerosis of the brachiocephalic arteries. It poses no less danger to human life, since the brain is affected. The 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.
- Speech function disorders.
Other neurological signs may also appear.
The next type of disease is atherosclerosis of the lower extremities. The main symptom of the pathology is lameness. It does not bother me all the time, but only during attacks of pain in the legs that interfere with normal movement.
Complications
Generalized atherosclerosis can cause serious complications if left untreated. They arise due to the fact that the disease provokes a narrowing of the vascular lumens. This entails the development of ischemia, hypoxia, and sclerosis.
As the plaque grows, vascular blockage occurs, which leads to poor circulation, acute vascular failure, heart attack, stroke, ruptured aneurysm and death.
Diagnostics
To identify vascular atherosclerosis, a comprehensive examination is carried out using laboratory and instrumental methods. These include:
- Blood test to determine cholesterol levels.
- X-ray to help identify diseased areas of the arteries.
- Angiography, which allows you to assess the condition of blood vessels and blood flow.
- Ultrasound examination visualizes blood vessels, which helps determine the location of the lesion.
If necessary, diagnostics is supplemented with other instrumental methods. Based on the data obtained during the examination, the doctor makes a final diagnosis and selects the most optimal treatment tactics.
Treatment
Treatment of generalized atherosclerosis is carried out using conservative and surgical methods. Patients are prescribed medications that lower cholesterol levels, strengthen vascular walls, and normalize blood circulation. Statins, fibrates, bile acid sequestrants, and nicotinic acid help with this.
Surgery is performed in severe cases when it is impossible to get rid of the pathology using a conservative method. To eliminate plaques, various operations are performed that help remove lipid thrombus and expand the lumen of the vessel.
Diet food
The goal of the diet is to normalize cholesterol levels. To achieve this, exclude from the diet all foods containing a lot of fat: fatty meat, butter, smoked meats, canned food.
The menu includes more plant foods: vegetables, fruits, herbs, cereals. You are allowed to eat lean meats and fish. You can drink green tea and natural juices.
Prevention
To prevent the development of atherosclerosis, the following is recommended:
- Follow the rules of healthy eating.
- To refuse from bad habits.
- Exercise.
- Monitor your body weight.
- Promptly treat pathologies that cause vascular problems.
- Avoid stress.
Generalized atherosclerosis is a serious disease that requires immediate treatment. Therefore, you cannot ignore elevated blood cholesterol levels and postpone a visit to the doctor.
Atherosclerosis is a polyetiological disease that affects the vascular wall and can manifest itself in different locations at different stages.
Let's analyze one of the most common forms of pathology - atherosclerosis of the blood vessels of the lower extremities - we'll talk about its symptoms and treatment, why it is dangerous and how it can be prevented.
Atherosclerosis of the lower extremities is a disease that affects the endothelium (inner lining) of the blood vessels of the legs. This happens due to an imbalance in lipid metabolism. main reason both atherosclerosis of the aorta and leg arteries - persistently and long-term increased levels of bad cholesterol in the blood. According to the international classification, atherosclerosis of the arteries of the legs has a code according to ICD 10: 170.2.
Plaques in blood vessels in the lower extremities
The disease manifests itself mainly in adulthood and old age, but its laboratory signs can be detected much earlier. Atherosclerosis can develop in the body for decades without showing any symptoms. The main arteries are most often affected. Gradually, the lumen of the vessel is closed by cholesterol plaques, and atherosclerosis takes on a wall-occlusive form. What's so special about her? In this clinical case, sclerotic masses mixed with lipids block the vascular lumen by more than half.
Simultaneously with this, destructive processes occur in the capillary sections of the circulatory system. Due to the occlusion of small collateral arteries, the trophism of the feet and joints is disrupted, and the clinical picture of the disease is formed.
Stages of development and symptoms
Inattention to health and lifestyle contribute to the progression of this disease of the limbs. More severe symptoms and life-threatening complications appear, and new foci of atherosclerotic lesions may appear. Experts distinguish a number of stages of atherosclerosis of the legs:
- Preclinical stage. During this period, there are still no external signs of the disease. But there is already a breakdown in lipid metabolism and the process has started. Trigger factors play a major role in this stage - excess weight, poor diet with excess fatty foods, physical inactivity, old age, and concomitant diseases. All of them accelerate the course of the disease. It is diagnosed only in the laboratory - tests indicate increased total cholesterol and its “bad” components - LDL and VLDL. In parallel with cholesterol, triglyceride levels also increase.
- First stage. During this period, the process of sclerosis of the vessels of the lower extremities has already started, but the clinical picture is not yet clearly expressed. Symptoms are practically absent, they can only appear with extreme loads, prolonged walking or running, and often do not attract due attention.
- Second stage. Here it is already difficult not to notice the manifestations of atherosclerosis. The severity of symptoms increases; even minor sports and physical activities can cause pain in the affected limbs. The maximum walking distance before pain syndrome is 250 meters. At this stage, the process may become chronic. Chronic Ischemia of the Lower Extremities develops - CLI - stage 2A of atherosclerosis.
- Third stage. Short and low-intensity loads cause discomfort and pain. The range of pain-free walking is reduced to 50 meters.
- The fourth stage is trophic disorders. Also found in the literature under the name “terminal”. This is the most severe stage of the disease. Due to total disturbances in the microcirculation of the veins and arteries of the legs and collateral blood supply, trophic non-healing ulcers form on the extremities, the skin darkens, necrotic areas appear (fragments of tissue necrosis), and the supply of oxygen to muscles and tissues is disrupted. Without urgent treatment, these processes can develop into gangrene.
Despite the presence of a long asymptomatic stage, when the patient does not show any complaints, the disease can be detected in the early stages and cured. With the growth of atherosclerotic plaques on the vascular walls, the clinical picture also expands. Usually, first signs– this is numbness of the skin of the feet, a feeling of goosebumps and tingling, a feeling of heaviness in the limbs.
Following this, due to stenosis and decreased vascular permeability, the pulsation of the arteries in the ankles, ankles and popliteal fossae decreases. A very important symptom is severe pain during exercise - which appears when walking. It is the nature, duration and localization of pain that determines how far the destructive process has gone.
Atherosclerotic manifestations in women and men are similar, with the exception that in the stronger half of humanity, the manifestation of the disease occurs in earlier years. The age of increased risk for men is over 40-45 years old, for women – over 50-55.
Diagnostics: how to check leg vessels for atherosclerosis
Before the first serious manifestations of atherosclerosis of the arteries of the lower extremities, the asymptomatic preclinical stage lasts quite a long time. On it, the disease can already be detected both laboratory and instrumental. And as you know, early detection of signs of atherosclerosis is the key to its successful treatment. Let's look at the most modern and effective diagnostic methods and their purpose. These include:
- Magnetic resonance angiography of the lower extremities.
- MSCT angiography.
- Peripheral and collateral arteriography.
- Calculation of pressure and ankle-brachial index.
- Palpation and listening to the pulsation of the vessels of the extremities.
- Duplex angioscanning.
- Consultation with a specialist – a vascular surgeon.
Causes of pathology and risk group
The main factors in the development of atherosclerosis of the lower extremities are metabolic disorders. In particular, a long-term and persistent increase in harmful blood cholesterol.
What is bad cholesterol? This concept usually includes two fractions of this fat - low and very low density lipoproteins (LDL and VLDL). These compounds have the property of sticking both to the wall of the vessel and to each other. When there is an excess of them in the circulating blood, they begin to stick and permeate the vascular wall. Then, in the foci of infiltration, a local inflammatory process occurs, new lipoproteins are layered on top of each other and atheromatous plaques are formed.
Similarly, an important reason for the development of the disease may be hereditary predisposition, which can be seen quite clearly in some patients. If the disease has persistently and steadily developed in close relatives, there is a high risk that it may manifest itself in you.
However, even despite genetic dependence, there are so-called at-risk groups. These are the categories of people in whom atherosclerosis is most likely to develop. These risk groups include:
- overweight people
- patients with underlying diseases - diabetes and/or arterial hypertension, severe infections
- people with negative habits – smoking and alcohol abuse
- males over 40 years of age
- suffering from arthritis - inflammation in the arterial walls of the legs
- patients with irregular diet and lifestyle - excess fatty foods against a background of physical inactivity.
Is it possible to cure atherosclerosis of the lower extremities?
Knowing how the disease develops, what stages it goes through and how it manifests itself, we will consider how to treat atherosclerotic lesions of the veins and arteries of the extremities. And is it even possible to clear the blood vessels on the legs from plaques?
First of all, before any drug treatment, you need to modify your lifestyle and diet. A low-cholesterol diet and dosed physical activity are prescribed. Until the second degree of progression of this vascular disease of the extremities, there is a great chance to improve your health without medication.
The gold standard for the treatment of atherosclerosis of the extremities is a technique developed by doctors in South Korea. It is expensive and is only carried out at their local clinics. The therapy is a cellular intervention - the patient is transplanted a group of stem cells into the lesion. These cells are regenerated and replace the damaged endothelium, clearing it of cholesterol and the patient's condition noticeably improves.
Unfortunately, domestic medicine does not have such technologies. The most common and effective methods in our clinics are restorative, drug and surgical therapy.
Drug treatment
Treatment of atherosclerosis should be comprehensive and individual. The treatment regimen is drawn up by a competent specialist based on test data and objective studies. Drugs from the group of statins (atorvastatin, rosuvastatin) or fibrates (gemfibrozil, fenofibrate), drugs that improve trophism and peripheral circulation in the lower extremities (pentoxifylline) are prescribed. Anticoagulants, vasodilators (vasodilators) and vitamin complexes are also included in therapy.
Class 9 Diseases of the circulatory system
I70-I79 Diseases of arteries, arterioles and capillaries
I70 Atherosclerosis
- I70.0 Atherosclerosis of the aorta
- I70.1 Atherosclerosis of the renal artery
- I70.2 Atherosclerosis of the arteries of the extremities
- I70.8 Atherosclerosis of other arteries
- I70.9 Generalized and unspecified atherosclerosis
I71 Aneurysm and aortic dissection
- I71.0 Aortic dissection of any part
- I71.1 Aneurysm of the thoracic aorta, ruptured
- I71.2 Thoracic aortic aneurysm without mention of rupture
- I71.3 Abdominal aortic aneurysm, ruptured
- I71.4 Abdominal aortic aneurysm without mention of rupture
- I71.5 Aneurysm of the thoracic and abdominal aorta, ruptured
- I71.6 Aneurysm of the thoracic and abdominal aorta without mention of rupture
- I71.8 Aortic aneurysm of unspecified localization, ruptured
- I71.9 Aortic aneurysm of unspecified location without mention of rupture
I72 Other forms of aneurysm
- I72.0 Carotid artery aneurysm
- I72.1 Aneurysm of the artery of the upper extremities
- I72.2 Renal artery aneurysm
- I72.3 Iliac artery aneurysm
- I72.4 Aneurysm of the artery of the lower extremities
- I72.8 Aneurysm of other specified arteries
- I72.9 Aneurysm of unspecified location
I73 Other peripheral vascular diseases
- I73.0 Raynaud's syndrome
- I73.1 Thromboangitis obliterans [Berger's disease]
- I73.8 Other specified peripheral vascular diseases
- I73.9 Peripheral vascular disease, unspecified
I74 Embolism and thrombosis of arteries
- I74.0 Embolism and thrombosis of the abdominal aorta
- I74.1 Embolism and thrombosis of other and unspecified parts of the aorta
- I74.2 Embolism and thrombosis of the arteries of the upper extremities
- I74.3 Embolism and thrombosis of the arteries of the lower extremities
- I74.4 Embolism and thrombosis of arteries of the extremities, unspecified
- I74.5 Embolism and thrombosis of the iliac artery
- I74.8 Embolism and thrombosis of other arteries
- I74.9 Embolism and thrombosis of unspecified arteries
I77 Other lesions of arteries and arterioles
- I77.0 Acquired arteriovenous fistula
- I77.1 Narrowing of the arteries
- I77.2 Artery rupture
- I77.3 Muscular and connective tissue dysplasia of arteries
- I77.4 Compression syndrome of the celiac trunk of the abdominal aorta
- I77.5 Arterial necrosis
- I77.6 Arteritis, unspecified
- I77.8 Other specified changes in arteries and arterioles
- I77.9 Changes in arteries and arterioles, unspecified
I78 Diseases of capillaries
- I78.0 Hereditary hemorrhagic telangiectasia
- I78.1 Non-tumor nevus
- I78.8 Other capillary diseases
- I78.9 Capillary disease, unspecified
I79* Lesions of arteries, arterioles and capillaries in diseases classified elsewhere
- I79.0* Aortic aneurysm in diseases classified elsewhere
- I79.1* Aortitis in diseases classified elsewhere
- I79.2* Peripheral angiopathy in diseases classified elsewhere
- I79.8* Other lesions of arteries, arterioles and capillaries in diseases classified elsewhere
Atherosclerosis of cerebral vessels (ICD-10 code: I67.2)
The second choice zones are the projection zones of the carotid arteries and vertebrobasilar arteries.
Rice. 84. Irradiation zones in the treatment of cerebral atherosclerosis. Legend: pos. “1” — projection of the carotid vessels, pos. “2” - projection of the vertebrobasilar vessels.
The projection zones of influence on the carotid arteries (Fig. 84, position “1”) are positioned in the middle of the anterior surface of the neck, medial to the inner edge of the sternocleidomastoid muscle. When irradiating the carotid arteries, it should be remembered that the pressor (nozzle) effect on the left carotid sinus can cause a significant decrease in blood pressure. The impact on the vertebrobasilar arteries is carried out at the level of 2-4 cervical vertebrae, 2.5 cm outward from the spinous processes.
The greatest effectiveness in treating the disease is achieved when the localization of atherosclerotic plaques is known, established on the basis of instrumental studies. It is preferable to carry out duplex scanning of the arteries with marking of the most affected areas of the artery.
Additionally, irradiation of the projection zones of the aortic arch and pulmonary trunk, paravertebral zones C3-C7 is performed.
Irradiation zones in the treatment of atherosclerosis of the vessels of the head
Obliterating atherosclerosis of the lower extremities
According to the international classification of diseases (ICD 10), obliterating atherosclerosis of the lower extremities is a disease of the leg arteries, characterized by their occlusive-stenotic lesions caused by excessive accumulation of cholesterol and lipids on the walls of blood vessels. Such lipid and cholesterol accumulations, called atherosclerotic plaques in medicine, can significantly increase in size as the disease progresses and thereby provoke the appearance of not only a fairly pronounced narrowing (stenosis) of the lumens of the arteries, but also their complete closure, which in most cases leads to ischemia of the lower extremities.
In order to most fully present the mechanism of pathological changes in this disease, it is recommended to familiarize yourself with medical sources containing various illustrations on the topic, as well as photos of obliterating atherosclerosis of the lower extremities.
Prevalence of the disease
Obliterating atherosclerosis of the arteries of the lower extremities is considered the most common vascular disease. According to generalized data from various medical studies, with atherosclerosis, occlusive-stenotic lesions of the arteries of the legs are found in 20% of patients. It is noted that this disease most often occurs in people belonging to a more mature age category. According to statistics, between the ages of 45 and 55 years, this disease is detected in only 3-4% of people, while at older ages it is detected in 6-8% of the population. It is also important to note the fact that atherosclerotic diseases are most often diagnosed in the male half, and in particular, in those men who abuse tobacco smoking for a long period of time.
Causes of the disease
Medical specialists are inclined to believe that the main reason for the development of the disease in question lies in lipid metabolism disorders, namely in a significant increase in the level of lipophilic natural alcohol (cholesterol) in the blood. However, they also note that the accumulation of cholesterol in the vessels alone is not enough to cause atherosclerosis. In order for atherosclerosis obliterans to develop, in addition to an increase in cholesterol levels, some risk factors must also be present that can adversely affect the structure and protective properties of the artery. Such factors include:
- mature age (45 years and older);
- gender (male);
- smoking (nicotine initiates the appearance of persistent vascular spasms, which often contributes to the development of various pathological processes);
- various serious illnesses (diabetes mellitus, hypertension, etc.);
- unhealthy diet (excess animal fats);
- lack of physical activity;
- overweight;
- excessive psycho-emotional and physical stress;
- frostbite of the extremities, as well as frequent hypothermia;
- previous leg injuries.
Currently, representatives of medicine believe that in addition to all of the above conditional causes of atherosclerosis, there is also a risk factor for the development of atherosclerotic diseases such as genetic predisposition. It has been scientifically proven that in some cases, an excessive increase in cholesterol in a person’s blood may be due precisely to his genetic inheritance.
Classification and symptoms of the disease
Symptoms of obliterating atherosclerosis of the lower extremities and their severity usually directly depend on the nature of the disease itself and the stage of its development. determined both by the degree of blockage of the artery and the severity of the resulting disturbances in the blood supply in the legs.
Modern medicine identifies four main stages of development of this disease, each of which is expressed by a specific clinical picture. These include:
- Stage 1 (is the initial asymptomatic stage of the disease, diagnosed by taking a biochemical blood test, which reveals elevated lipid levels);
- stage 2 (expressed by the appearance of primary signs of the disease in the form of numbness, chilliness, muscle cramps and mild pain in the lower extremities);
- stage 3 (characterized by a fairly pronounced clinical picture, in which severe pain appears in the legs, lameness may be observed, and thinning of the skin and the formation of small bleeding wounds and ulcers are detected);
- Stage 4 (defined as the most severe and is expressed by the appearance of constant pain, muscle atrophy, total lameness, as well as the occurrence of gangrene and trophic ulcers). Medical specialists warn that obliterating atherosclerosis of the vessels of the lower extremities is a serious and dangerous disease, untimely treatment of which can lead to the appearance of gangrene of the leg with its subsequent loss. This means that if any of the above symptoms occur, it is important to immediately consult a doctor in order to promptly diagnose and treat the developed disease.
Diagnosis of the disease
The diagnosis of “obliterating atherosclerosis ICD 10 code 170” is made on the basis of the collected anamnesis, manifested clinical signs, as well as laboratory and instrumental research methods, including passing some tests (urine, blood) and undergoing a number of special medical examinations (rheovasography, Dopplerography, thermometry, arteriography and functional load tests).
Treatment of the disease
After carrying out all the necessary diagnostic procedures followed by making an accurate diagnosis, the doctor individually prescribes to the patient the most suitable treatment for obliterating atherosclerosis. When drawing up a treatment regimen for this disease, the doctor always takes into account the stage of its development, the severity of existing ischemic disorders and the presence or absence of any complications.
Relief of pathological processes in atherosclerotic diseases can include both a set of therapeutic and health measures aimed at adjusting everyday lifestyle, as well as conservative, endovascular or surgical methods of treatment.
Treatment and health measures in such cases include:
- to give up smoking;
- hypocholesterol diet food;
- elimination of existing diseases and pathologies that aggravate the course of atherosclerosis;
- dosed physical activity;
- prevention of hypothermia of the skin of the legs and feet, as well as their protection from injury.
Treatment of obliterating atherosclerosis of the lower extremities, carried out conservatively, involves the use of physiotherapy, the use of antibiotic ointments, as well as the use of various vasodilators, vitamins, antispasmodics and drugs that improve tissue nutrition and blood microcirculation.
Endovascular treatments include balloon dilatation, angioplasty and arterial stenting. In modern medicine, these treatment methods are considered to be fairly effective non-surgical methods of restoring blood circulation through the vessels.
Surgical treatment is carried out only when a number of severe complications arise against the background of severe ischemia that is resistant to medication. The main surgical methods for treating atherosclerosis of the legs are: prosthetics (replacement of the affected part of the vessel with a prosthesis), bypass surgery (restoration of blood flow using an artificial vessel), thromboendarterectomy (liquidation of the affected artery).
In cases where gangrene appears against the background of atherosclerotic disease, multiple necrosis of leg tissue is observed, and it is not possible to restore blood flow through surgery, amputation of the affected part of the leg is prescribed.
Progressive atherosclerosis is one of the main causes of disability caused by amputation of the lower extremities, and, therefore, for each patient suffering from this disease, it is important to begin in time to carry out all the necessary treatment procedures and strictly follow the basic medical instructions and recommendations.
For many people, the word “sclerosis” is associated with memory impairment that occurs in old age. In fact, it is a vascular disease that can affect the arteries of any part of the body. Thus, atherosclerosis of the vessels of the lower extremities (ICD code 10 - 170.2) is a disease in which blockage of the femoral or popliteal arteries occurs.
Disruption of blood flow in large vessels of the legs due to narrowing of their duct or complete blockage is not uncommon. Atherosclerosis of the arteries of the lower extremities is especially common in men after 40 years of age.
The first signs of the disease: pain in the calves during physical activity and long walking. In the later stages, symptoms of impaired tissue trophism appear - dry and bluish skin, the formation of poorly healing ulcers. Gangrene may develop.
Types of disease
A distinction is made between non-stenotic and stenotic atherosclerosis, although in essence they are the same disease. Simply, non-stenotic sclerosis is the initial stage of the disease. At this stage, a narrowing of the lumen of blood vessels is noted by less than 50%.
Advice! We can say that non-stenotic atherosclerosis is a sign of age. Almost all people over 50 years old can show signs of this disease.
However, non-stenotic vascular sclerosis, in the presence of provoking factors, progresses and the disease enters a more severe stage. The main symptoms of progressive atherosclerosis of the blood vessels of the legs:
- the appearance of a feeling of chilliness, a tingling sensation or “goosebumps”;
- increased fatigue, pain in the legs even with minor exertion;
Advice! The more severely the vessels are affected, the less time the patient can walk before pain appears. In the later stages, pain occurs even at rest.
- pale skin of the legs, especially in the foot area. The skin color becomes “marbled”, dryness and flaking are noted. Fragility and brittleness of toenails;
- in the later stages, trophic ulcers appear on the skin, which heal very poorly.
- Raynaud's syndrome;
- thromboangitis;
- endarteritis, etc.
To clarify the diagnosis, the following examinations may be prescribed:
- Dopplerography – ultrasound and radiopaque. This study allows you to assess the volume of blood flow in the affected limbs and the speed of blood movement through the vessels;
- Ultrasound angioscanning allows you to assess the condition of the arterial walls;
- Peripheral angiography is a study aimed at determining the extent of pathological changes in blood vessels and the degree of their damage.
Treatment
The main goals pursued by the treatment of atherosclerosis of the vessels of the lower extremities:
- eliminate unpleasant symptoms, relieve pain when walking;
- increase endurance to physical activity by training with a gradual increase in the distance traveled without pain;
- preventing progress in vascular damage. In later stages, prevention of the formation of trophic ulcers.
Therapeutic methods
In the initial stages, drug treatment gives good results. To effectively treat atherosclerosis, it is necessary to use drugs aimed at reducing the concentration of cholesterol in the blood, strengthening the walls of blood vessels, and improving tissue nutrition.
To successfully treat such a serious disease as atherosclerosis with damage to the blood vessels of the legs, it is necessary to approach the problem comprehensively. In addition to using medications, it is important to change your lifestyle. Patients need:
- Stop smoking. Without giving up this bad habit, you should not count on success in treatment.
- Follow a diet. It is important to exclude foods that increase cholesterol levels from your diet. And, above all, significantly reduce the consumption of animal fats.
- Do physical education. Physical activity is a prerequisite for healing. However, the loads must be dosed. The training program should be drawn up together with a specialist.
So, atherosclerosis of the blood vessels of the legs is a serious disease, which, according to the International Classification of Disease, 10th edition (ICD 10), is assigned code 170.2. Treatment should begin in the early stages and approach the problem in a comprehensive manner.
