Acute ascending thrombophlebitis ICD code 10. Causes of the development of the disease. For this purpose, the following events are carried out

Excluded:

Phlebitis and thrombophlebitis:
- complicating:
  - abortion, ectopic or molar pregnancy (O00-O07, O08.7)
  - pregnancy, childbirth and the puerperium (O22.-, O87.-)
- intracranial and spinal septic or NOS (G08)
- intracranial non-pyogenic (I67.6)
- spinal non-pyogenic (G95.1)
- portal vein (K75.1)
postphlebitic syndrome (I87.0)
thrombophlebitis migratory (I82.1)

Thrombophlebitis code according to ICD-10

In the majority of patients with thrombophlebitis (about 90%), the disease affects the deep veins of the lower extremities. Thrombophlebitis of the lower extremities is a pathological condition characterized by inflammatory process, occurring in the walls of the vessel, the formation of a blood clot in this place, resulting in a significant deterioration in blood flow. Damage to the venous trunks often indicates endocrine diseases, disorders of the coagulation balance of the blood and an imbalance of homeostasis.

Formed blood clots can completely block the blood flow in the vessel, or they can dissolve without a trace. Thrombotic masses are able to break away from their base and move freely along the bloodstream, leading to blockages in a completely different place in the body (for example, a blood clot from the deep venous vessels of the leg can lead to blockage pulmonary artery).

In order to correctly determine the presence of thrombosis and its nature (localization, acute process or chronic, the presence of a floating tail), to carry out a correct diagnosis of the disease with a prognosis of its possible complications, as well as for continuity between doctors of different specialties and different medical institutions, it is necessary to own and correctly use classification of pathological condition.

Classification of the disease

Systematization of types of thrombophlebitis of the lower extremities:

According to the type of course: acute (no more than one month), subacute (up to three months) and chronic process (after three months it develops into postthrombophlebitic disease). You can also highlight an exacerbation of a chronic process.
By localization: a process involving the superficial (subcutaneous trunks and their branches) and deep veins of the lower extremities and pelvic cavity (phlebothrombosis).
According to the nature of the process: purulent, non-purulent.
By etiology: infectious or aseptic (associated with blood pathologies, varicose veins, cancer, in pregnant women with complications in the third trimester, complicated childbirth, hormonal diseases, injuries, allergies, infectious diseases).

Phlebothrombosis of the deep veins of the legs has its own division depending on the location of the process:

deep venous trunks of the leg;
deep venous vessels of the leg and popliteal trunk;
deep veins of the leg, popliteal and femoral venous trunks;
iliofemoral localization.

In addition to the above systematic groups, for correct diagnosis and statistical recording of the number of cases, it is important to correctly enter the pathological process into the international rubricator of ICD-10.

International disease code

At the head of statistics in health care and the systematization of all pathological conditions is the document “International Statistical Classification of Diseases and Health-Related Problems.” It was created through the efforts of the World Health Organization. The document is reviewed by it once a decade with a view to making amendments. Since 1999 Russian Federation ICD-10 (tenth updated edition) is used.

The main feature of ICD-10 is its alphanumeric encryption technique. This code uses one Latin letter and three numbers. The classification is divided into 21 classes, which correspond to the first letter of the ICD-10 code. Classes are divided into blocks of different headings.

In accordance with ICD-10, thrombophlebitic lesions of the superficial and deep veins of the lower extremities belong to class I00-I99 Diseases of the circulatory system. This class includes blocks describing rheumatic heart pathologies, disorders caused by high pressure blood, cerebrovascular diseases, ischemic and other heart pathologies.

Lesions of the veins, lymphatic trunks and nodes, not systematized in other headings, including diseases of the peripheral superficial or deep vessels of the lower extremities, belong to block I80-I89.

Thrombophlebitis of the superficial and deep vessels of the legs belongs to the combined category of phlebitis and thrombophlebitis. This category has its own subsection in the ICD-10 classification: nosological class I80 Phlebitis and thrombophlebitis. This subsection covers endophlebitis, perivenous and intrinsic inflammation of the venous trunks, including purulent. Thrombophlebitic processes that complicate medical termination of pregnancy, childbirth and the immediate days after childbirth, pathological post-inflammatory intracranial blockages, blockages of spinal cord, portal vein and migratory vessels, as well as postphlebitic syndrome are not included in the subsection.

I80 Phlebitis and thrombophlebitis:

I80.0 superficial vessels of the legs.
I80.1 femoral venous vessel.
I80.2 other deep vessels.
I80.3 lower extremities of uncertain location.
I80.8 other location.
I80.9 unspecified localization.

Thrombophlebitic lesions of the superficial veins of the lower extremities are coded I80.0. This painful condition requires a differential diagnosis with thromboangiitis obliterans I73.1, lymphangitis I89.1 and periarteritis nodosa M30.0.

Damage to the deep veins of the lower extremities is encrypted under code I80.3. Conduct differential diagnosis thrombophlebitis with thrombosis of the arterial trunks I74.3–I74.5, obliterating endarteritis I70 and symmetrical gangrene (Raynaud's disease) I73.0.

ICD-10 does not indicate whether the process is acute or chronic.

The eleventh revision of the international disease register (ICD-11) is planned for 2018. Unlike ICD-10, subsequent classification will take into account etiology, clinical and diagnostic signs, effect on pregnancy and quality of life.

Deep vein thrombosis of the lower extremities

Deep vein thrombosis of the lower extremities: Brief description

Deep vein thrombosis of the lower extremities is the formation of one or more blood clots within the deep veins of the lower extremities or pelvis, accompanied by inflammation of the vascular wall. May be complicated by impairment venous outflow and trophic disorders of the lower extremities, phlegmon of the thigh or lower leg, as well as pulmonary embolism Phlebothrombosis - primary thrombosis of the veins of the lower extremities, characterized by fragile fixation of the blood clot to the vein wall Thrombophlebitis - secondary thrombosis caused by inflammation of the inner lining of the vein (endophlebitis). The thrombus is firmly fixed to the wall of the vessel. In most cases, thormbophlebitis and phlebothrombosis are combined: pronounced phenomena of phlebitis are found in the zone of primary thrombus formation, i.e., the head of the thrombus, while in the zone of its tail there are no inflammatory changes in the vascular wall.

Frequency

Deep vein thrombosis of the lower extremities: Causes

Etiology

Pathomorphology

Deep vein thrombosis of the lower extremities: Signs, Symptoms

Clinical picture

Deep venous thrombosis (confirmed by venography) has classic clinical manifestations in only 50% of cases.

The first manifestation of the disease in many patients may be pulmonary embolism.

Complaints: a feeling of heaviness in the legs, bursting pain, persistent swelling of the lower leg or the entire limb.

Acute thrombophlebitis: increased body temperature to 39 ° C and above.

Local changes Pratt's symptom: the skin becomes glossy, the pattern of the saphenous veins clearly protrudes Payr's symptom: pain spreads along the inner surface of the foot, leg or thigh Homans' symptom: pain in the lower leg when dorsiflexing the foot Lowenberg's symptom: pain when the lower leg is compressed by the cuff of a blood pressure device value 80–100 mm Hg. Art. , while compression of the healthy lower leg is up to 150–180 mm Hg. Art. does not cause unpleasant sensations. The diseased limb is colder to the touch than the healthy one.

With pelvic vein thrombosis, mild peritoneal symptoms and sometimes dynamic intestinal obstruction.

Deep vein thrombosis of the lower extremities: Diagnosis

Instrumental studies Duplex ultrasound angioscanning using color Doppler mapping is the method of choice in diagnosing thrombosis below the level of the inguinal ligament. The main sign of thrombosis: detection of echo-positive thrombotic masses in the lumen of the vessel. The echo density increases as the “age” of the thrombus increases. The valve leaflets cease to differentiate. The diameter of the affected vein increases by 2–2.5 times compared to the contralateral vessel, the vein stops responding to compression by the sensor (a sign that is especially important in the first days of the disease, when the thrombus is not visually distinguishable from the normal lumen of the vein) Non-occlusive parietal thrombosis is clearly identified by color mapping - the space between the thrombus and the vein wall is painted blue. The floating proximal part of the thrombus has an oval shape and is located centrally in the lumen of the vessel. X-ray contrast retrograde iliocavagraphy is used in cases where thrombosis extends above the projection inguinal ligament, since ultrasound of the pelvic vessels is difficult due to intestinal gas. The catheter for administering the contrast agent is inserted through the tributaries of the superior vena cava. During angiography, it is also possible to implant a vena cava filter. Scanning using 125I fibrinogen. Serial scanning of both lower extremities is performed to determine whether radioactive fibrinogen is included in the blood clot. The method is most effective for diagnosing thrombosis of the veins of the leg.

Differential diagnosis

Deep vein thrombosis of the lower extremities: Treatment methods

Treatment

Mode

Patient management Bed rest for 1–5 days, then gradual restoration of normal physical activity with refusal of long-term immobilization The first episode of deep phlebothrombosis must be treated for 3–6 months, subsequent episodes - at least a year. During the administration of heparin intravenously, the time is determined blood clotting. If 3 hours after administration of 5000 units the coagulation time exceeds the initial one by 3–4 times, and after 4 hours by 2–3 times, the administered dose is considered sufficient. If blood clotting has not changed significantly, increase the initial dose by 2500 units. Monitoring of blood platelets is necessary; if they decrease below 75´ 109/l, heparin administration should be stopped. When treating with phenindione, PTI must be monitored daily until the required values are reached (maximum - 25–30%), then weekly for several weeks, after which (with stabilization) monthly for as long as the drug is taken, the possibility of significant bleeding (for example, hematuria or gastrointestinal bleeding) should be considered, since anticoagulant therapy often unmasks cancer, peptic ulcer or arteriovenous defects.

Thrombosis of the lower extremities ICD 10

Thrombophlebitis is a disease (code 180 according to ICD 10), which is a lesion of the venous vessels external factors leading to the formation of blood clots. It often manifests itself in conjunction with diseases such as:

haemorrhoids;
thrombosis of the portal venous vessels;
thrombosis and embolism of veins;
varicose veins of the lower extremities;
varicose veins of the esophagus;
lymphadenitis (not subject to specific systematization);
varicose veins of certain areas of the body (mucous membranes);
insufficiency of venous vessels;
non-contagious pathologies of the body's lymphatic system;

Included in the ninth section of the ICD, entitled “Unqualified diseases of the veins, lymphatic vessels and nodes.”

Formed blood clots can completely block the blood flow in the vessel, or they can dissolve without a trace

Thrombophlebitis ICD 10 may imply a type such as deep vein thrombophlebitis. The reason for this lies in the fact that there is no independent concept of this pathology in the system, therefore, it does not have a code according to ICD 10. Thrombophlebitis of the lower extremities has 4 subsections in the international classification of diseases, which, in turn, can also be divided. Therefore, in the main document upon discharge, the name of the entire section of the disease is written, and the note specifies its type and features, for example, acute or chronic form.

If there are several diseases that have their own separate codings for thrombophlebitis according to the ICD system, it is necessary to use generalized values when preparing documentation. That is, the principle of minimizing the use of ciphers is applied, for example, the need to simultaneously write codes 180.01 and 180.02 is replaced by using 180.03 encoding.

ICD 10 system

First you need to figure out what the abbreviation “ICD-10” or, translated into English, ICD-10 means. Essentially, this is the name given to a document created World Organization healthcare, its name stands for “international classification of diseases”. It provides the ability to unite all diseases into a specific system to facilitate their recording in patient records, which allows the entered information to be correctly perceived in any medical institution, regardless of the location of the latter and language barriers. The number, in our case “10,” indicates the serial number of the document revision. The Russian Federation switched to the ICD-10 system at the end of the twentieth century.

The main feature of ICD-10 is its alphanumeric encryption technique

Through this innovation, it became possible to simplify the processing and analysis of information about the incidence of the population in a certain territory. The main difference between the ICD and previous methods of entering data was the transformation of specific names and types of diseases into codes, the design of which occurs using numbers and letters (four characters: the first is a Latin letter, and the next three are designated by numbers). Statistical studies are also carried out based on the international classification of diseases.

History of systematization

The first experimental attempt to systematize pathologies known to the world was made by Francois de Lacroix. The result of his work was the “Methodology of Nosology”. It is also necessary to note such researchers as John Graunt (determining the percentage of infant mortality in early age), Wales William Farr and Mark d'Espin. The last two doctors managed to create the most acceptable systematized classification of diseases for 1855, consisting of 139 points. It was this that became ICD No. 1, which was subsequently revised 9 more times. The last analysis of the system took place in 1989, after which the diseases received a new coding.

Causes of thrombophlebitis

This pathology can occur due to several reasons, including:

Reducing the speed of blood movement through the vessels.
Oncological diseases.

Acute deep vein thrombosis can occur for various reasons

External impact on venous blood vessels, causing mechanical damage to the wall structure.
The presence of an inflammatory process in the body.
Consequences of surgical operations.
Special conditions that cause hormonal imbalances, such as pregnancy.
Physiological processes that provide stress on the body’s circulatory system (childbirth).
The presence of varicose veins of the lower extremities and infectious diseases.
Disturbances in the central nervous system.
Deviation from normal blood clotting indicators.
Presence of allergic reactions.

Occurrence of the disease

The first symptoms of a disease such as thrombophlebitis of the deep veins of the lower extremities (ICD.2) are mild pain and the appearance of signs of an inflammatory process (redness, increased body temperature). Next, certain areas of the skin thicken and the limb where the blood clot is located swells. The general condition is characterized by painful sensations when walking.

Symptoms of the disease do not appear immediately. However, over time, the patient may experience heaviness in the legs

Diagnosis of thrombophlebitis

This disease can be detected by using:

Laboratory research. With their help, one of the signs of the disease can be identified - the inflammatory process.
Instrumental methods. These include:

rheovasography;
Dopplerography - performed using ultrasound;
double-type anti-scanning - characterized by the use of ultrasound and color coding of blood flow;
ultrasound scanning.

Treatment

Methods for getting rid of thrombophlebitis are divided into conservative and surgical. The former are suitable for use at home, while the latter require mandatory hospitalization. medical institution(departments for vascular and phlebological diseases).

Most often, thrombophlebitis is treated with drug therapy

The latter is a necessity in the presence of forms of thrombophlebitis characterized by the threat of deep vein thrombosis. Surgery can be performed in the form of ligation or removal of the affected venous vessels.

Conservative treatment involves addressing symptoms such as inflammation skin and the formation of blood clots. In addition, the appointment of such measures denies a long stay in bed. An active lifestyle promotes a speedy recovery, as movement increases the speed of blood flow, which, in turn, prevents the formation of problematic blood clots in the venous vessels.

You can alleviate the patient’s condition using the following methods:

use of elastic bandages (with severe inflammation processes);
the use of special stockings or tights (compression treatment);
short-term cooling on a certain area of the skin (pain relief).

Diclofenac is considered a good remedy for combating thrombophlebitis.

In addition to them, for thrombophlebitis it is possible to use several groups medications, among them:

Anti-inflammatory drugs (non-steroidal):

"Diclofenac". You can purchase it in tablet form, as injections and ointments.
"Ketoprofen". Available in the form of a gel, it is used several times daily by lightly rubbing onto the surface of the affected skin.

These drugs, among other things, have an analgesic effect.

With their help, the walls of venous vessels are strengthened and inflammatory processes are reduced.

To relieve swelling, preparations based on rutin are ideal. For example, you can use Venoruton, Troxevasin or Troxerutin

Disaggregants:

"Reopoliglyukin";
"Trainal."

Injections for intravenous administration and infusion. Mixtures containing polyenzyme substances. The advantages of their use are an anti-inflammatory effect, relief from swelling and strengthening of the immune system.
Phlebotonic drugs. They are distinguished by the absence of chemical components.

Medicines that have an anticoagulant effect, as well as exposure to variable magnetic field and modulated sinusoidal current.

The choice of a set of drugs for each patient requires an individual approach from a specialist, since there may be other diseases that can progress due to the use of certain medications. Conservative treatment methods cannot promise complete recovery, especially if the underlying cause of the disease has not been identified. Therefore, during the entire period of treatment, it is necessary to regularly monitor the patient’s condition.

Preventive measures

Thrombophlebitis (TMB) most often appears due to the development chronic diseases veins and lymphatic vessels of the lower extremities (MBK.2). Therefore, to prevent pathology, you need to monitor the blood vessels of the legs and promptly treat diseases that provoke thrombophlebitis, especially varicose veins.

It is necessary to lead a healthy and active lifestyle, this will help prevent blood stagnation in blood vessels. Such measures are relevant both in the case of already cured thrombophlebitis and in order to avoid its occurrence.

The diet also has great importance when carrying out prophylaxis. Food should not burden the stomach; you should eat less fat and more carbohydrates. Vitamin-mineral complexes and immunomodulators will be useful.

Diagnosis of “thrombophlebitis of the lower extremities” (code 180 according to ICD 10)

Complications after thrombophlebitis of the lower extremities with an ICD code are dangerous to life and health. This acute illness, caused by inflammation of the venous wall, disruption of the normal outflow of blood from the vessel and the formation of a blood clot in the lumen of the vein.

Causes of venous thrombophlebitis

Under the influence of a damaging factor, primary thrombophlebitis develops.

The trigger - the trigger - is the influence of the following factors:

Impact of infectious pathogens on the vein wall.
Traumatic damage to tissue near the vessel wall. Closed bone damage especially often causes deep vein thrombophlebitis. Its code is in ICD.2. As a result of frequent microtraumas of the skin and the proximity of the skin, inflammatory changes in thrombophlebitis of the superficial veins, which has code 180.0 in ICD-10, develop very quickly.
When the nutrition of the vein tissue is disrupted, aseptic inflammation develops.
Chemical agent. Intravenous administration of irritants.
As a result, infectious thrombophlebitis develops. In the aseptic form of the disease, a limited area of the venous vessel is affected.

As a complication after certain ailments, a secondary form of thrombophlebitis occurs:

This is a local lesion of the veins of an allergic type or intoxication due to scarlet fever, brucellosis, influenza, or typhoid fever.
After various types of surgical interventions, postoperative deep vein thrombophlebitis develops. Thrombosis is promoted by forced positioning of the patient for a long time, trauma to the venous wall, strict postoperative bed rest, damage to soft tissues, and infectious complications.
Various enzymes and toxins damage the venous wall during pneumonia and typhus.
Allergic changes in the body and a specific change in its sensitivity predispose to thrombus formation.
Diseases circulatory system increase the coagulability of liquid tissue.
Malignant tumors contribute to changes in the composition of the body's fluid tissue.

Thrombophlebitis of the veins of the lower extremities is the most common complication after varicose veins:

Patients have valvular insufficiency great saphenous vein, perforating vessels, tributaries of the great saphenous veins.
There are situations when the saphenous vein expands in diameter up to 1 cm. This leads to venous stagnation of blood in the lower extremities.
Pathological reflux develops. This is the flow of venous blood along the main trunk of the great saphenous vein.

Damaging factors of varicose veins:

Impaired blood flow and stagnation.
Increased intravascular coagulation.
Dystrophic changes in the tonic state of the vascular wall as a result of increased levels of glycosaminoglycans, thickening of the inner lining, and age-related changes.
Violation of blood outflow is most often accompanied by the process of abnormal platelet adhesion. This is the adhesion of blood platelets to the damaged vessel wall.
There is a reflux of venous blood from the deep system into the saphenous veins.
Increased blood clotting and pathological thrombus formation are observed in the saphenous vein on the inner surface of the lower leg or on the thigh.

The nature of the development of inflammation of the veins determines the pathological process:

Purulent melting of tissues.
Inflammatory infiltration, purulent thrombophlebitis.

Clinical picture of the pathology

Such patients experience:

Progression of varicose veins.
Persistent circulatory disorders. The patient suffers from acute pain and swelling of the limb.
Patients note that skin hyperpigmentation and cyanosis develop. On the inner surface of the lower leg and thigh there is hyperemia - redness of the skin.
When palpating the limb in this area, patients feel severe pain.
The temperature in most cases rises to 37.3-37.4 °C.
There is induration - thickening of the skin.
All these changes ultimately lead to trophic ulcers.

Most patients with subcutaneous thrombophlebitis seek medical care quite late. They continue to lead their usual lifestyle and work. And then the most problematic situation occurs - ascending thrombophlebitis of the great saphenous vein. At the same time, the blood clot level rises higher knee joint. This becomes a complication that is dangerous to life and health, because an intraluminal thrombus in this area of the leg can progress to the saphenofemoral anastomosis (groin area) or move to the common femoral vein. The most embolic danger is a floating thrombus floating in the bloodstream.

Diagnosis of the disease

Research is required:

Lab tests. General blood coagulability and prothrombin index are determined.
Ultrasound examination to determine the presence of thrombosis and the nature of the clot.
Venography. Contrasting the affected veins makes it possible to see deep and superficial veins and identify the presence of risk factors for the development of thrombosis.

Tactics and methods of treatment

There are two principles in the treatment of this disease:

It is necessary to prescribe thrombolytics to the patient. Such medications help the body quickly cope with a blood clot. It is important to stop the growth of the blood clot, dissolve the embolus and prevent its migration.
If such drugs are contraindicated for the patient, a special device is placed in the venous vessel, which serves as a trap for the pathological thrombus, preventing it from moving up the vessels.

If pain occurs along the affected veins, consultation with a vascular surgeon is necessary.

Treatment of thrombophlebitis of the lower extremities, which in the international classification of diseases ICD-10 is listed as dangerous disease, requires some effort from the patient and persistence from the doctor.

Thrombophlebitis of the lower extremities ICD 10

Varicose veins MED PLUS

Code according to ICD-10 varicose veins of the upper extremities

Material from Wikipedia - the free encyclopedia

Varicose veins. Varicose veins on the right lower limb. ICD-10 I8383. ICD

Varicose veins of the lower extremities (varicose veins) is an expansion of the superficial veins of the lower extremities, accompanied by valve failure and impaired blood flow. The term "varicose veins" comes from the Latin. varix. genus. n. varicis - “swelling”.

Story

Varicose veins have accompanied humanity since its inception. Mentions of this disease can also be found in the Old Testament[ source not specified 97 days], and by Byzantine authors. Its antiquity is also confirmed by excavations of the Mastaba burial in Egypt (1595-1580 BC), where a mummy was found with signs of varicose veins and a treated venous trophic ulcer of the leg. Outstanding doctors of antiquity - Hippocrates, Avicenna, Galen - also tried to treat this disease.

Considering the presence of reflux through the saphenofemoral anastomosis to be the cause of varicose veins, Friedrich Trendelenburg ( German) in 1880 proposed to carry out ( German) through a transverse incision in the upper third of the thigh, ligation and intersection of the great saphenous vein (GSV). Alexey Alekseevich Troyanov (1848-1916) used a test similar to Trendelenburg to diagnose valvular insufficiency of the great saphenous vein, and for the treatment of varicose veins he recommended using a double ligature of the great saphenous vein “with cutting out”. However, both authors did not insist on the need for ligation of the GSV at the level of the sapheno-femoral anastomosis, which caused the appearance large quantity relapses in those days.

At the turn of the 19th - 20th centuries, existing operations were supplemented by extremely traumatic dissections of the tissues of the thigh and leg with deep (to the fascia) circular or spiral incisions according to N.Schede (1877,1893), Wenzel, Rindfleisch (1908), with the aim of damaging the saphenous veins with subsequent by bandaging or tamponade to heal by secondary intention. The severe consequences of these operations due to extensive scarring, damage to nerves, arteries and lymphatic pathways led to their complete abandonment. At the beginning of the 20th century, there were about two dozen methods of surgical treatment of varicose veins. Of the entire arsenal of proposed methods, only a few were most often used, namely: the methods of O.W.Madelung, W.Babcock, S.Mayo, N.Schede. The method of removing the GSV proposed by W.W. Babcock in 1908 was a kind of breakthrough in the treatment of varicose veins of the lower extremities. The use of a metal probe was the first intravascular effect on venous vessels, the first step towards minimal invasiveness, which made it possible to reduce the negative consequences of other surgical techniques. In 1910, M. M. Diterikhs proposed mandatory ligation of all trunks and tributaries of the great saphenous vein, for which he used an arcuate incision 2 cm above the inguinal fold, descending to the thigh, widely opening the area of the oval fossa and allowing the large saphenous vein and its tributaries to be resected. The basic principles of surgical treatment of primary varicose veins were determined in 1910 at the X Congress of Russian Surgeons. It was emphasized that a carefully performed operation eliminates the possibility of relapse of the disease. The next stage in the development of methods for treating chronic venous diseases was due to the development and implementation of radiological diagnostic methods.

The first X-ray contrast study of veins in Russia was carried out in 1924 by S. A. Reinberg, who injected a 20% solution of strontium bromide into varicose nodes. The further development of phlebography is also firmly connected with the names of Russian scientists A. N. Filatov, A. N. Bakulev, N. I. Krakovsky, R. P. Askerkhanov, A. N. Vedensky.

With the advent of complex ultrasound angioscanning with color mapping of blood flows and Dopplerography, it became possible to study the anatomy of the venous system of each individual patient, the relationship of veins to other superficial structures (fascia, arteries), the time of blood reflux, the extent of reflux along the trunk of the GSV; It became possible to study the functioning of perforating veins. The search for opportunities to minimize surgical trauma led to the idea of intravascular impact, which would distance the zone of trophic disorders from the impact zone. Sclerotherapy as a method of intravascular exposure to chemicals appeared after the invention of the syringe in 1851 by Charles-Gabriel Pravaz. Pravets administered iron sesquichloride to obtain aseptic phlebitis; other doctors administered chloral hydrate, carbolic acid, iodine tannin solution, and soda solutions. In 1998-1999, the first reports by Boné C. appeared on the clinical intravascular use of a diode laser (810 nm) for the treatment of chronic venous diseases.

Prevalence

The prevalence of varicose veins is unusually wide. According to various authors, up to 89% of women and up to 66% of men from the population of developed countries have its symptoms to one degree or another. A large study carried out in 1999 in Edinburgh showed the presence of varicose veins of the lower extremities in 40% of women and 32% of men. An epidemiological study conducted in 2004 in Moscow demonstrated that 67% of women and 50% of men have chronic diseases of the veins of the lower extremities. A study conducted in 2008 in another region of the Russian Federation - on the Kamchatka Peninsula - demonstrated a similar situation: chronic diseases of the veins of the lower extremities were more common in women (67.5%) than in men (41.3%). Increasingly, there are reports of this pathology being detected in schoolchildren.

Development mechanism

Formation of varicose veins. A normally functioning vein without pathology of the venous valves (A). Varicose veins with a deformed valve, impaired blood flow, and thin, stretched vein walls (B).

The trigger mechanism in the development of varicose veins is considered to be a disruption of the normal functioning of the venous valves with the occurrence of reverse flow (reflux) of blood. At the cellular level, this is due to an imbalance in the physiological balance between muscle cells, collagen and elastic fibers of the venous wall.

At the initial stage, in the presence of genetic risk factors and provoking circumstances (for example, prolonged standing), a slowdown in venous blood flow occurs. This changes the so-called shear-stress a parameter that is a set of indicators of blood movement through a vessel to which the endothelium responds. Endothelial cells respond to these changes and initiate a mechanism known as leukocyte rolling.

Due to interactions that have not yet been sufficiently studied, leukocytes rush to the endothelium and “roll” along its surface. If the provoking factor acts long time, then leukocytes are firmly fixed to endothelial cells, thereby activating the process of inflammation. This process of inflammation spreads along the venous bed of the lower extremities, causing and combining with dysfunction of endothelial cells, and then damage to the full thickness of the venous wall. This process occurs especially quickly in venous valves, which are subject to constant mechanical stress.

As a rule, the valves that are subject to maximum mechanical stress are the first to be affected. In this case, pathological discharge of blood occurs through the mouth of the great and small saphenous veins, sometimes through large perforating veins. Excessive blood volume arising in the superficial veins gradually leads to overstretching of the venous wall. The total volume of blood contained in the superficial venous bed of the lower extremities increases. This increased blood volume continues to drain into the deep system through the perforating veins, overstretching them. As a result, dilatation and valvular insufficiency occur in the perforating veins.

Now, during operation of the muscular venous pump, part of the blood is discharged through incompetent perforating veins into the subcutaneous network. So-called “horizontal” reflux appears. This leads to a decrease in the ejection fraction during the “systole” of the muscular venous pump and the appearance of additional volume in the superficial bed. From this moment on, the work of the muscular venous pump loses its effectiveness.

Dynamic venous hypertension occurs - when walking, the pressure in the venous system ceases to decrease to the levels necessary to ensure normal blood perfusion through the tissues. Chronic venous insufficiency occurs. First, swelling appears, then along with the fluid in subcutaneous tissue formed elements of blood (erythrocytes, leukocytes) penetrate. Lipodermatosclerosis and hyperpigmentation occur. With further persistence and deepening of microcirculation and blood stasis disorders, skin cells die and a trophic ulcer occurs.

Symptoms

The leading symptom of varicose veins is the expansion of the saphenous veins, which is why the disease got its name. Varicose veins usually appear at a young age, in women - during or after pregnancy. IN initial stages The disease produces few and very nonspecific symptoms. Patients are bothered by a feeling of heaviness and increased fatigue in the legs, bloating, burning and sometimes night cramps in the calf muscles. One of the common symptoms that appears at the very beginning of the disease is transient swelling and pain along the veins (often not yet dilated). With varicose veins of the legs, there is slight swelling of the soft tissues, usually in the feet, ankles and lower legs. This entire symptom complex differs so much from patient to patient that practically the only successful name for it is “heavy leg syndrome” (not to be confused with “heavy leg syndrome”). restless legs"). Availability is not required of this syndrome predisposes to subsequent varicose vein transformation. However, most patients with varicose veins veins of the lower extremities at the onset of the disease, any of the listed symptoms were noted. All these symptoms are usually more pronounced in the evening, after work, or during prolonged standing, especially in hot weather.

The disease develops slowly - over years, and sometimes decades. Subsequently, the listed subjective symptoms are joined by swelling that regularly appears in the evening and disappears in the morning. Swelling is first observed in the ankles and dorsum of the foot, and then spreads to the lower leg. When such edema appears, one should speak of developed chronic venous insufficiency. The skin color takes on a bluish tint. If patients at this stage do not receive the necessary treatment, a certain part of them develop hyperpigmentation of the skin of the legs and lipodermatosclerosis. In more advanced cases, trophic ulcers occur.

Danger of the disease

It is not varicose veins that are dangerous, but the thrombophlebitis that appears against its background. Thrombophlebitis (inflammation of the inner wall of a vein) leads to the formation of blood clots, which can block the lumen of the vein with the formation of phlebothrombosis, and also, breaking away from the vessel wall, enter the lungs through the inferior vena cava system. In this case, pulmonary embolism may occur, which is a serious complication and sometimes ends in death. There are a number of therapeutic measures aimed at preventing this condition (for example, a vena cava filter), but they must begin with a consultation with a phlebologist and a blood clotting study.

Classification

The most pathogenetically substantiated is the classification proposed in 2000 in Moscow at a meeting of leading domestic specialists in the field of venous pathology. This classification takes into account the form of the disease, the degree of chronic venous insufficiency and complications caused directly by varicose veins.

Forms of varicose veins

I. Intradermal and segmental varicose veins without pathological venovenous discharge
II. Segmental varicose veins with reflux along superficial and/or perforating veins
iii. Common varicose veins with reflux along the superficial and perforating veins
IV. Varicose veins in the presence of reflux in the deep veins

Based on the experience of treating tens of thousands of patients, the main clinical signs of chronic diseases of the veins of the lower extremities were selected. These signs were arranged into 6 clinical classes (“C”), in increasing severity (rather than stages), from telangiectasias (TAE) to trophic ulcers. In addition to the clinical part, an etiological section (“E”) has appeared, indicating whether the process is primary or not. The third, anatomical part of the classification (“A”) divided the entire venous system of the lower extremities into 18 relatively separate segments. This allows you to accurately indicate the location of the lesion in the venous system of the lower extremities. The last, pathophysiological section (“P”) indicates the presence of reflux and/or obstruction in the affected venous segment. In 2004, this classification was refined and recommended for use in phlebological practice throughout the world. Undoubtedly, the negative side of the Cear classification is its cumbersomeness. It is very difficult, and sometimes impossible, to keep all 40 points in memory.

I. Clinical classification. (WITH)

II. Etiological classification (E)

EU: Congenital disease
Ep: Primary with unknown cause.
Es: Secondary with a known cause: post-thrombotic, post-traumatic and others.
En: The cause of the disease cannot be determined

iii. Anatomical classification (A)

IV. Pathophysiological classification.

V. Clinical scale (scoring).

Pain: 0 - absent; 1 - moderate, not requiring painkillers; 2 - severe, requiring painkillers.
Edema: 0 - absence; 1 - minor moderate; 2 - pronounced.
“Venous claudication”: 0 - absence; 1 - light-moderate; 2 - strong
Pigmentation: 0 - none; 1 - localized; 2 - common.
Lipodermatosclerosis: 0 - absence; 1 - localized; 2 - common.
Ulcer, size (largest ulcer): 0 - absent; 1 -<2 см в диаметре; 2 - >2 cm in diameter;
duration of ulcer existence: 0 - absence; 1 -<3 мес.; 2 - >3 months;
recurrence of ulcer: 0 - absence; 1 - once; 2 - repeatedly.
number of ulcers: 0 - absence; 1 - single; 2 - multiple

VI. Disability scale

0 - asymptomatic.
1 - the presence of symptoms of the disease, the patient is able to work and does without supportive measures.
2 - the patient can work for 8 hours only with the use of supporting agents.
3 - the patient is unable to work, even with the use of supportive measures.

To facilitate the perception and use of this classification, the concepts of “basic” ceap and “extended” ceap are introduced. The first means an indication of the clinical sign with the greatest significance, an indication of the cause, an anatomical indication of one of the three venous systems, and an indication of the leading pathophysiological sign. The extended version indicates absolutely all the indicators that a given patient has. In addition, it is advisable to indicate the clinical level of examination in the diagnosis:

The date of the examination must also be indicated. Thus, the diagnosis: Varicose veins. Varicose veins of the right lower limb with reflux along the great saphenous vein to the knee joint and perforating veins of the leg. hvn 2 is encrypted as follows:

Main ceap: C3, Ep, As, p, Pr
Extended ceap: C 1,2,3,S, Ep, As, p, Pr, 2,18, lii 03/19/2009

Varicose veins of the lower extremities are a surgical disease, so radical treatment is only possible surgical methods. People with risk factors and a hereditary predisposition to varicose veins need to consult a phlebologist once every 2 years with mandatory ultrasound examination veins

Surgical methods

Phlebectomy

Phlebectomy is surgery for the removal of varicose veins. Modern phlebectomy is a combined intervention and includes three stages:

Endovasal (endovenous) laser coagulation (obliteration) of varicose veins (evlk, evlo) is a modern minimally invasive method of treating varicose veins. The method does not require incisions or hospitalization.

Radiofrequency coagulation (ablation) of varicose veins (rchk, rcha) is a method of endovenous treatment of varicose veins of the saphenous veins of the lower extremities, the purpose of which is to eliminate reflux through the great and/or small saphenous vein. The procedure for radiofrequency coagulation of varicose veins is performed under ultrasound guidance, under local anesthesia, without incisions and without hospitalization.

Sclerotherapy

A modern method of eliminating varicose veins consists of injecting a special drug into the vein that “glues” the vein. Sometimes it is performed under ultrasound control.

Conservative treatment

Conservative treatment of varicose veins should not be opposed to surgical treatment. It is used in conjunction with it, complementing it. As the main treatment, it is used when it is impossible to perform surgical intervention. Conservative treatment does not lead to a cure for varicose veins, but they help improve well-being and can slow down the rate of progression of the disease. Conservative treatment is used:

The main objectives of conservative treatment of varicose veins are:

elimination of signs of CVI;
prevention of disease relapse;
maintaining ability to work;
improving the quality of life of patients.

Compression therapy

Compression treatment of chronic venous insufficiency has ancient roots; it is known that Roman legionnaires used bandages made of dog skin, which were used to tighten the calves of the legs during long marches to prevent swelling of the legs and bursting pain. The leading component in the conservative treatment program is compression treatment. Its effectiveness has been confirmed by numerous studies. The effect of compression treatment is multicomponent and consists of the following:

Depending on the nature of the pathology and the goals pursued, compression treatment can be used for a limited or long period. IN clinical practice For compression treatment, elastic bandages and compression hosiery are most often used. Despite the widespread use of the latter, elastic bandages have not lost their importance. Bandages with short and medium stretch are most often used. Medium stretch bandages are used in the treatment of varicose veins, when for one reason or another it is impossible to use compression stockings. They create a pressure of about 30 mmHg. Art. both in a standing and lying position. Short stretch bandages create high “working” pressure in a standing position (40-60 mm Hg). The pressure in the supine position is significantly lower. They are used in the treatment of advanced forms, accompanied by edema, trophic disorders, even ulcers. Sometimes, when it is necessary to achieve an even higher “working” pressure, for example, with the development of lymphovenous insufficiency, as well as trophic ulcers, a so-called elastic bandage is used. It involves the simultaneous use of bandages of varying degrees of extensibility. The pressure created by each bandage is summed up. An elastic bandage is wound from the base of the fingers, and the heel is necessarily bandaged. Each round of the bandage should cover the previous one by about 1/3. When choosing products such as stockings, tights or knee socks for compression therapy, it must be remembered that compression bandages must clearly correspond to the individual parameters of the patient. It is also necessary to take into account that different manufacturers offer their own measurement schemes. But the tables for determining the size of compression hosiery are always based on the circumference lengths of the ankle, shin and upper third of the thigh.

Drug therapy

Medicines for the treatment of varicose veins must meet the following criteria:

Phlebotropic drugs used today can be divided into several groups:

For the prevention and treatment of varicose veins, it is important correct image life.

Varicose veins MedPlus

ICD 10 phlebothrombosis

14 Feb 2015, 18:30 |

... the fate of a patient with acute venous thrombosis largely depends on timely and objective diagnosis, competent therapeutic and preventive measures.

The following factors can serve as triggers for ileofemoral thrombosis. trauma, bacterial infection, prolonged bed rest, postpartum period, contraceptives, disseminated intravascular coagulation. The causes of deep vein thrombosis of the lower extremities can be benign and malignant formations, mainly of the pelvis, as well as aneurysms abdominal aorta, iliac and femoral arteries, popliteal cysts, pregnant uterus. Among malignant tumors, cancer of the sigmoid colon, ovary, kidney and adrenal gland, pancreas, cervix or retroperitoneal sarcoma predominates. Other causes include retroperitoneal fibrosis and iatrogenic venous injury.

IN clinical course acute ileofemoral thrombosis, a prodromal stage and a stage of severe clinical manifestations. In peripheral paths of development, unlike the central one, there is no prodromal stage as such.

The prodromal stage is manifested by increased temperature and pain of various localizations. Pain can occur in the lumbosacral region, lower abdomen and in the lower limb on the affected side. More often, pain in one location or another begins gradually and is dull, aching in nature.

The stage of severe clinical manifestations is characterized by the classic triad: pain, swelling and discoloration. The fighting becomes intense, diffuse, covering the groin area, anteromedial surface of the thigh and calf muscle. The swelling is widespread, affecting the entire lower limb from the foot to the inguinal fold, sometimes spreading to the buttock and is accompanied by a feeling of fullness and heaviness in the limb. Compression of arterial vessels by edematous tissues and their spasm are the cause of acute ischemia of the limb, expressed in sharp pain in its distal parts, impaired sensitivity in the foot and lower third of the leg, absence of pulsation of the artery, starting from the popliteal and sometimes femoral level.

Changes in skin color can vary from pale (white sore phlegmasia, phlegmasia alba dolens) to cyanotic (blue sore phlegmasia, phlegmasia coerulea dolens). White painful phlegmasia occurs due to spasm of the accompanying arteries and is accompanied by pain. Blue painful phlegmasia is secondary to white phlegmasia. It comes almost complete violation outflow of blood through the femoral and iliac veins due to their occlusion. Strengthening the “pattern” of the saphenous veins on the thigh, and especially in the groin area, is a very informative and important symptom.

The general condition does not suffer much. Therefore, if the development of acute ileofemoral thrombosis is accompanied by a sharp deterioration in general condition, then it is most often associated with some complication - incipient venous gangrene, thrombosis of the inferior vena cava, pulmonary embolism.

The diagnosis of acute phlebothrombosis of the deep veins of the lower extremities, including ileofemoral thrombosis, can be confirmed by the following main methods of special diagnostics: duplex (triplex) scanning; radiopaque descending or ascending venography; radionuclide phlebography Tc99m in case of intolerance to radiocontrast agents, scanning with fibrinogen labeled I131.

Differential diagnosis should be made with occlusive arterial diseases and erysipelas. Edema of the limb, characteristic of deep venous thrombosis, is possible with chronic lymphostasis (elephantiasis), cellulite, contusion of the calf muscle or rupture of the tendons of the foot. A calf muscle contusion or torn tendon in the foot can cause swelling, pain, and tenderness in the area. The acute onset of symptoms during exercise and ecchymosis in the calf area confirm the muscular origin of these symptoms.

In some cases, venography is required to establish the correct diagnosis to avoid unnecessary anticoagulant therapy and hospitalization. Bilateral lower extremity edema is usually due to cardiac or renal failure or hypoalbuminemia. In addition, pain can be caused by peripheral neuritis, lumbosacral radiculitis, arthritis and bursitis. If the patency of the arteries of the lower extremities is impaired, pain also occurs, but without swelling and dilatation of the superficial veins.

Principles of therapy. All patients are prescribed treatment in a surgical (angiosurgical) hospital. The patient must be transported to the hospital in a lying position; bed rest is required before the examination. In cases where there are no conditions for a full examination of patients (ultrasound scanning, phlebography), they should be prescribed anticoagulants while the patient remains in bed for 7-10 days. For the treatment of acute venous thrombosis, three main groups of drugs are used: anticoagulants; fibrinolytics and thrombolytics; disaggregants.

Low molecular weight heparins, unfractionated heparin and fondaparinux pentasaccharide are used for anticoagulant therapy. With thrombolysis (streptokinase or urokinase), there is one problem - the incidence of bleeding and mortality increases. In addition, recanalization occurs only in 1/3 of cases. Therefore, thrombolysis is used only in exceptional cases - for example, in young people (less than 50 years old) with recent (less than 7 days) widespread thrombosis.

Thrombolytic therapy for ileofemoral thrombosis is carried out only after installing a vena cava filter, as it promotes the migration of blood clots into the pulmonary artery with the development of its thromboembolism. The vena cava filter is shaped like an umbrella with holes for blood to pass through. The filter was installed in the infrarenal segment of the inferior vena cava by percutaneous insertion of a special device in which the vena cava filter is in a collapsed state. The guidewire together with the vena cava filter can be inserted through jugular vein or the femoral vein of the contralateral side. Recently, local thrombolysis has become relevant.

Surgical interventions for deep vein thrombosis, including ileofemoral thrombosis, are performed only for health reasons and directly depend on their embologenicity (danger of pulmonary embolism). Embologenic thrombosis (floating head of a thrombus) is surgically treated; surgical treatment is also used when there is a threat of venous gangrene and the spread of the thrombotic process to the inferior vena cava.

The type of operation depends on the location of the thrombosis. In this case, the operation is possible only on veins of medium and large diameter (popliteal, femoral, iliac, inferior vena cava). Operations of removing a blood clot, applying an arteriovenous shunt, installing a vena cava filter, etc. can be used. Some operations, in addition to preventing the upward spread of thrombosis, also aim to remove thrombotic masses. However, radical thrombectomy is feasible only in the early stages of the disease, when thrombotic masses are not firmly fixed to the intima of the vessel.

Retrograde removal of a thrombus from the left iliac veins through a phlebotomy hole in the femoral vein is not always feasible due to its compression by the right iliac artery, the presence of intravascular septa and adhesive process in the lumen of the common iliac vein. Thrombectomy from the right iliac veins is associated with the risk of pulmonary embolism.

Bypass operations have not become widespread due to the complexity of the technique and frequent thrombosis. When thrombectomy from the iliac vein requires careful adherence to measures to prevent pulmonary embolism - insertion of a second obturator balloon from the healthy side into the inferior vena cava with closed method operations or application of a provisional tourniquet to the vena cava in the open method.

The formation of blood clots in the legs is a serious pathology that requires immediate treatment or surgery. Thrombosis is an insidious disease with unpredictable consequences. How to recognize pathology, and what treatment methods exist?

International classification of thrombosis

Thrombosis of the veins of the lower extremities ICD 10 is included in the group “Varicose veins”, which includes three volumes with encodings and decodings. In it, deep vein thrombosis of the lower extremities ICD 10 is indicated under code I80. This disease is characterized by such symptoms as inflammation of the venous walls, circulatory disorders, and the formation of blood clots in the lumen between the veins. These symptoms cannot be ignored, otherwise the blood clot may break off and travel to nearby organs, which can lead to death.

Venous thrombosis is characterized by the appearance of a blood clot (thrombus) in the venous lumen

Causes and symptoms of thrombophlebitis

Thrombophlebitis ICD 10 can be provoked by the following factors:

infectious diseases occurring in the body;
mechanical damage to bones and soft tissues;
failure in the process of tissue nutrition;
Availability chemical substance inside vascular connections;
taking synthetic hormones;
pregnancy;
increased blood clotting;
bad habits;
obesity;
cardiovascular diseases.

Types of thrombophlebitis of the lower extremities

Thrombophlebitis can occur in the acute or chronic phase. It is also divided into two varieties:

Mesenteric.
Ileofemoral.

In the acute phase, intense symptoms are observed with unbearable pain that intensifies when walking. To relieve and moderately alleviate symptoms, take analgesic and anti-inflammatory drugs (Analgin, Nimesulide, Diclofenac). When the first symptoms appear, you should immediately consult a doctor; treatment takes place in a medical facility with constant monitoring vascular condition.

The chronic stage is characterized by all of the above symptoms, but the symptoms are less pronounced. This phase is also characterized by dry wounds, ulcers, and purulent abscesses. Chronic venous insufficiency may occur.

Mesenteric thrombosis is characterized by spontaneous failure of blood flow. Pathology develops against the background of separated thrombosis. This phenomenon is favored by heart diseases, birth defects heart, atherosclerosis, varicose veins, sepsis, stroke, myocardial infarction, tachycardia, cardiosclerosis, complications after surgery.

Treatment of pathology

Treatment is carried out within the walls of a hospital facility. The patient is advised to take anticoagulants that prevent blood clotting and antiplatelet agents that reduce the blood's ability to form blood clots. Physiotherapy is also effective for thrombosis. The procedures are carried out under the supervision of a doctor. In the acute phase, the patient is prescribed bed rest. After exiting the critical period, you can begin moderate physical activity while wearing special compression hosiery. This will tone your legs and normalize blood supply to the veins.

Excluded:

Phlebitis and thrombophlebitis:
- complicating:
  - abortion, ectopic or molar pregnancy (O00-O07, O08.7)
  - pregnancy, childbirth and the puerperium (O22.-, O87.-)
- intracranial and spinal septic or NOS (G08)
- intracranial non-pyogenic (I67.6)
- spinal non-pyogenic (G95.1)
- portal vein (K75.1)
postphlebitic syndrome (I87.0)
thrombophlebitis migratory (I82.1)

Deep vein thrombosis of the lower extremities is the formation of one or more blood clots within the deep veins of the lower extremities or pelvis, accompanied by inflammation of the vascular wall. May be complicated by impaired venous outflow and trophic disorders of the lower extremities, phlegmon of the thigh or lower leg, as well as pulmonary embolism Phlebothrombosis - primary thrombosis of the veins of the lower extremities, characterized by fragile fixation of the blood clot to the vein wall Thrombophlebitis - secondary thrombosis caused by inflammation of the inner lining of the vein (endophlebitis). The thrombus is firmly fixed to the wall of the vessel. In most cases, thormbophlebitis and phlebothrombosis are combined: pronounced phenomena of phlebitis are found in the zone of primary thrombus formation, i.e., the head of the thrombus, while in the zone of its tail there are no inflammatory changes in the vascular wall.