Chr thrombophlebitis code according to ICD 10. What characterizes acute thrombosis

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.

Frequency

Etiology

Pathomorphology

Clinical picture

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.

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 the entire time 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 ulcers, or arteriovenous defects.

Classification of thrombophlebitis according to ICD 10: what nuances do you need to know?

Thrombophlebitis in ICD 10 (International Classification of Diseases, 10th version) is defined as a condition in which a blood clot forms in a vein, inflamed due to a certain external intervention. Thrombophlebitis in the ICD is in the section “unclassified diseases of veins, lymphatic vessels and nodes.” This section (No. IX) contains a classification of codes for diseases of the circulatory system, which relate to veins, lymph nodes and vessels. I80 - thrombophlebitis has had this ICD code since 2007. Moreover, in the following subsections with codes I81-I89 there are diseases such as:

portal vein thrombosis (I81);
venous embolism and thrombosis (I82). This sub-item includes blockage of the femoral, caval, renal, and other veins specified in the description.
varicose veins on the legs are in section I83;
hemorrhoids are assigned code I84;
esophageal varicose veins - I85;
varicose veins that are located in places not specified in the above subparagraphs (for example, on the retina, scrotum, vulva, etc.) – I86;
venous insufficiency, postthrombophlebitis syndrome (undertreated thrombophlebitis) ICD code 10 I87;
nonspecific lymphadenitis - I88;
lymphangitis, lymphedema and other disorders of the lymphatic system that are defined as non-contagious - I89.

Thrombophlebitis: classification and interpretation of subsection I 80

Patients who are trying to more seriously understand ICD 10 know that deep vein thrombophlebitis is not highlighted as an independent subitem. When making a diagnosis, the doctor can use both terms from the ICD “thrombophlebitis of the deep veins of the left lower extremity” and apply synonymous general concepts. So, for example, acute thrombophlebitis in ICD 10 is not listed as a separate subitem at all. But, despite this, the patient can find such a diagnosis on his sick leave. But if you need an extract for transfer to a foreign hospital, then the card will indicate not acute thrombophlebitis, but the ICD 10 code of the main name of the disease. For example, thrombophlebitis of the deep veins of the lower extremities in ICD 10 code: I80.293 (if both extremities were affected); code I80.291 (if only the right leg is affected), or code I80.292 if only the left leg is affected. Therefore, in accordance with disease coding guidelines, the stage of the disease may be indicated in the discharge transcript.

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There are also several guidelines regarding the assignment of an ICD code for thrombophlebitis of the lower extremities. In fact, this is a very general name, because thrombophlebitis of the lower extremities in ICD 10 is devoted to as many as 4 paragraphs (I80.0, I80.2, I80.29, I80.3). Moreover, each of the four sections is subdivided into several more subsections, which decipher the localization of thrombophlebitis of the lower extremities (ICD 10 code can indicate which leg or arm was affected). For example: if a diagnosis of “superficial thrombophlebitis of the veins of the lower extremities” is made, in ICD 10 there is code I80.0 for this. But if the doctor cannot accurately determine whether one leg or two are affected, then the card will say I80.00. If the symptoms and results of diagnostic tests performed clearly indicate that a specific limb has been affected, then the chart will read I80.01 for the right, I80.02 for the left, and I80.03 if both legs are affected. By default, the chronic stage of the disease is assumed, but if the doctor wants to draw the attention of colleagues to the fact that the patient has acute thrombophlebitis, the ICD code is set to the same, and a note is added to the extract.

What ICD code will be assigned if disease of the veins of the lower extremities is not the patient’s only problem?

The directive encourages doctors to minimize the number of codings in one card. So, for example, it is impossible to indicate the codes I80.01 and I80.02 in one card, because the code I80.03 was developed to generalize them. This small feature is the main advantage of the tenth revision classifier, namely the maximum minimization of notes and subjective comments from attending physicians.

The introduction of unified codes throughout the world saved patients from translator errors and ambiguous interpretation of diagnoses. Just 10 years ago, when transferring from one hospital to another, especially a foreign one, a patient had to translate dozens of pages of medical history. Naturally, this could lead to errors and inaccuracies. Now, when changing doctors, the patient receives only a card with a set of numbers and letters. Of course, working on a classifier is quite intensive and cumbersome. Changes are constantly being made to it, and it is likely that acute thrombophlebitis will soon receive its own code in the ICD. This will save both patients and doctors from problems with additional notes in the medical record.

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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 an inflammatory process occurring in the walls of the vessel, the formation of a blood clot in this area, 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 of the 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, the Russian Federation has used ICD-10 (tenth updated reissue).

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 blood pressure, 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. A differential diagnosis of thrombophlebitis is carried out 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.

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 is an acute disease 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 of the 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 of the great saphenous vein, perforating vessels, and 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 help 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. In this case, the level of the blood clot rises above the 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 a dangerous disease, requires certain efforts from the patient and perseverance of the doctor.

ICD 10 deep vein thrombosis of the lower extremities

Thrombophlebitis is a disease (code 180 according to ICD 10), which is damage to the venous vessels by 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. In fact, this is the name of the document created by the World Health Organization; 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 at an 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 the norm of 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 in a 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 treating symptoms such as skin inflammation and blood clot formation. In addition, the appointment of such measures denies a long stay in bed. An active lifestyle promotes a speedy recovery, since 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 of medications, including:

Anti-inflammatory drugs (non-steroidal):

"Diclofenac". You can buy 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 an alternating magnetic field and modulated sinusoidal current, also help well.

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 (TBC) most often appears due to the development of chronic diseases of the veins and lymphatic vessels of the lower extremities (TBC.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 the blood vessels. Such measures are relevant both in the case of already cured thrombophlebitis and in order to avoid its occurrence.

Diet is also of great importance when carrying out prevention. Food should not burden the stomach; you should eat less fat and more carbohydrates. Vitamin-mineral complexes and immunomodulators will be useful.

ICD-10 - Deep vein thrombosis of the lower extremities: all about pathology

Deep vein thrombosis is a very common and dangerous disease. It occurs more often in women than in men, especially after the age of 40. At least a quarter of the world's population has thrombosis.

The disease is based on increased blood clotting and the formation of a clot in the lumen of the vein. This is one of the main causes of pulmonary embolism, which occurs due to the detachment of a blood clot, so do not forget about the serious consequences of thrombosis.

ICD-10 - what is it? Causes of the disease

Deep vein thrombosis is a disease in which blood clots form in the deep veins

Several factors contribute to the formation of a blood clot in the lumen of a vein: damage to the venous wall, slow blood flow and an increased number of platelets. As a result of all these factors, a blood clot is formed, which is most often localized in the lower extremities, since the blood flow is slow here.

Deep vein thrombosis of the lower extremities ICD-10 is one of the most common pathologies. ICD-10 is a generally accepted international classification of diseases, where each disease is assigned its own code. Deep vein thrombosis of the lower extremities has code 180 and is described as a disease accompanied by an inflammatory process of the venous walls and circulatory disorders.

The consequence of this disease can be fatal, so it is not recommended to ignore it.

Among the causes of deep vein thrombosis are:

Hormonal imbalances. It is precisely because of frequent hormonal disorders that women suffer from thrombosis approximately 5 times more often than men. The risk of blood clots increases during pregnancy, taking hormonal medications, and during menopause.
Phlebeurysm. In fact, any disease of the veins and blood vessels can lead to thrombosis. With varicose veins, the walls of the veins stretch and blood stagnates in them, which significantly increases the risk of blood clot formation.
Inflammation of the veins. The inflammatory process can occur due to infection, injury, or improper intravenous injection. In this case, the integrity of the venous wall is disrupted, so a blood clot forms in the area of damage.
Oncological diseases. With cancer, metabolic processes are disrupted, so blood clotting increases, which leads to the formation of blood clots in the lumen of blood vessels and veins.
Excess weight. In overweight people, the concentration of leptin, which is similar to female sex hormones, increases in the blood. This process occurs in the body of both men and women. It increases blood thickness and increases platelet adhesiveness. This leads to thrombosis.

Also among the provoking factors are addiction to alcohol, smoking, poor diet and physical inactivity, and old age.

Types of thrombosis and main symptoms

Blood clots prevent normal blood flow

There are acute and chronic thrombophlebitis. However, most often they occur sequentially. That is, first an acute form occurs, when the symptoms can be more pronounced, and after 2-3 months they subside, but this only means that the disease has entered a chronic stage and will periodically worsen.

In most people, deep vein thrombosis is asymptomatic at first. The patient does not complain about anything and does not feel much discomfort. Even if signs of the disease are present, they may be uncharacteristic of the disease. In about half of all cases, symptoms are not recognized correctly.

The most common signs of thrombosis include:

Pain of a bursting nature. Pain in the leg may appear after walking or staying in one position for a long time. Most often, the pain is quite intense and long-lasting.
Heaviness in the legs. This is one of the initial symptoms that may indicate both varicose veins and thrombosis. Towards the end of the day, heaviness in the legs appears, but at first it goes away after rest.
Edema. The swelling of the affected area is quite persistent and does not subside even when there is no load on the leg. The higher the blood clot is located in the thigh, the more noticeable and noticeable the swelling. The entire leg may swell.
Hyperthermia. Elevated body temperature (above 39 degrees) does not always appear. As a rule, it serves as an indicator of an acute inflammatory process and occurs with acute deep vein thrombophlebitis.
Pratt's sign. This is one of the most accurate indicators of deep vein thrombosis. The affected area of skin on the leg acquires a glossy shine and a venous pattern appears on it.
Change in limb temperature. As a rule, the limb affected by thrombosis is colder to the touch than the healthy one.
Change in skin color. In some cases, the affected area of skin becomes slightly lighter and turns pink. If edema is present, thrombosis can be immediately suspected.

The asymptomatic course of the disease is considered the most dangerous, since the onset of the disease can be missed. The patient consults a doctor only if he already has complications.

Diagnosis of the disease

To assess blood flow in the deep veins, duplex scanning and ultrasound scanning are used

It is very important to diagnose the disease in time and determine the location of the blood clot. The effectiveness of treatment largely depends on this. To determine the disease, both laboratory examinations and functional tests are carried out.

First of all, you need to see a doctor. A phlebologist treats such diseases. Modern medicine allows us to fully examine the vessels and veins of the body, assess blood flow and make a correct diagnosis.

Diagnostic methods to determine deep vein thrombosis include:

Phlebography. This is an examination of deep veins using x-rays. The standard procedure will not show the vascular and venous network, so before the x-ray the patient is injected with a contrast agent. Since the procedure involves the introduction of substances and ionizing radiation, it can have a number of side effects. Phlebography is prescribed to make a final diagnosis if other examination methods are not sufficiently informative. If the procedure is performed incorrectly, inflammation may occur due to infection.
Ultrasound examination of the veins of the lower extremities. This type of examination is carried out using an ultrasound machine. With this procedure, blood flow can be assessed and the exact location of the clot can be determined. Unlike phlebography, there is no harmful radiation, so the procedure is absolutely safe. Using ultrasound, you can assess the condition of deep veins, their patency, the presence of a blood clot and even its mobility. The picture is displayed on the monitor dynamically.
Radionuclide scanning (scintigraphy). This type of examination is more often used to diagnose various bone and joint diseases. The essence of the method is that radioactive isotopes are introduced into the patient’s body, and then their radiation is recorded using a special device.

Tests include Louvel's sign (pain in the leg increases with sneezing and coughing), as well as marching. The patient is given elastic bandages over the entire leg from the toes to the groin. After this, he walks for some time at a marching pace. Then the bandages are removed. If the patient has pain or veins are visible, we can talk about deep vein thrombosis.

Treatment and prognosis

Thrombectomy is indicated for severe circulatory disorders in the lower extremities

Treatment is carried out taking into account the patient's condition. It can be either conservative or surgical. In the initial stages of thrombosis, treatment is carried out at home with bed rest. In more severe cases, the patient is hospitalized.

Treatment methods for deep vein thrombosis include:

Taking anticoagulants. These drugs thin the blood and prevent blood clots from forming. Most often I use the direct-acting drug Heparin in the form of injections. The dosage is determined individually. In case of thrombosis, rather aggressive therapy with the use of anticoagulants is prescribed, but it can significantly reduce the risk of death.
Anti-inflammatory therapy. To relieve inflammation, Voltaren or Analgin are prescribed. They not only reduce the inflammatory process, but also relieve swelling and help thin the blood.
Physiotherapy. Procedures such as electrophoresis and magnetic therapy may be prescribed. They help relieve pain and stop the progression of the disease.
Thrombectomy. This type of surgery is used in the initial stages of the disease. The operation will only be effective if the blood clot has formed recently. It is removed, the vein is sutured and blood flow is restored. After surgery, you need to follow the rules of prevention to avoid relapse.
Installation of filters. The vena cava filter is installed into the lumen of the inferior vena cava. The filter has the shape of an umbrella and is designed to stop a detached blood clot. This will avoid pulmonary embolism if the blood clot breaks off.

Drug treatment should be accompanied by adherence to the regimen, proper nutrition, and bandaging of the limb with an elastic bandage.

The prognosis largely depends on the stage at which the disease is detected, the age of the patient and the course of thrombosis.

If the blood clot is located above the lower leg and proper treatment is not provided, then in more than 20%, the disease leads to pulmonary embolism, which in turn often ends in death. When the blood clot is localized in the lower leg area, the prognosis is more favorable, since the risk of severe complications is minimal.

Consequences and prevention

Thrombosis can cause chronic venous insufficiency

Thrombosis can lead to serious consequences, including the death of the patient. The most dangerous consequence is a pulmonary embolism, when a blood clot blocks a pulmonary artery, cutting off the blood supply to the lung.

Acute respiratory failure develops, as well as cerebral edema, which can lead to death without emergency medical care.

Another dangerous consequence is the addition of a bacterial infection. Purulent thrombophlebitis can lead to pus entering the bloodstream and the appearance of sepsis.

To avoid the development of deep vein thrombophlebitis or to prevent a relapse, you need to adhere to the rules of prevention:

Follow the diet and drinking regime. Proper nutrition supports the functioning of the cardiovascular system and reduces the likelihood of the formation of atherosclerotic plaques. Water keeps the blood fluid and prevents the formation of blood clots. In the absence of kidney disease, you need to drink up to 2 liters of clean water per day.
Enough to move. Physical inactivity leads to excess weight and stagnation of blood in the legs. It is not necessary to actively engage in sports. To prevent thrombosis, daily walks or gymnastics will be enough.
Temper yourself and visit the pool. Cool water not only strengthens the immune system, but also helps prevent thrombosis. It has a strengthening effect on veins and blood vessels, helping to maintain their elasticity.
Avoid static loads. For veins, staying in the same position for a long time is especially harmful. Representatives of sedentary professions are advised to take breaks and stretch.
Use of compression stockings. Such knitwear can be worn not only by those who already have problems with veins, but also for prevention. For example, compression garments are recommended for those who have a hereditary predisposition to thrombosis and for women during pregnancy.

From the video you can learn about the diet for deep vein thrombosis:

By following these rules, you can significantly reduce the risk of blood clots. It is also recommended to undergo a medical examination once a year for preventive purposes, so as not to miss the onset of the disease.

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Thrombophlebitis code according to ICD 10

Varicose veins of the lower extremities pregnancy

Varicose disease of the lower extremities is the expansion and lengthening of the saphenous veins of the legs as a result of pathological changes in their walls and valve apparatus, which are persistent and irreversible.

The incidence is 3 per 1000 pregnant women, which is 5–6 times more common than in non-pregnant women. In 80%, varicose veins appear for the first time during pregnancy. During pregnancy, thrombophlebitis of the superficial veins and deep vein thrombosis of the lower extremities are most often observed.

I82 Embolism and thrombosis of other veins.

O22 Venous complications during pregnancy.

O22.0 Varicose veins of the lower extremities during pregnancy.

International classification for assessing the state of the venous system CEAP:

“C” (Clinical signs - clinical classification) - based on objective clinical signs with the addition: A - for asymptomatic course and C - for symptomatic.

“E” (Etiologic classification - etiological classification) - takes into account congenital primary and secondary disorders.

“A” (Anatomic distribution - anatomical classification) - characterizes the anatomical localization of venous lesions (superficial, deep or perforating veins).

“P” (Pathophysiologic dysfunction - pathophysiological classification) - is based on the assessment of venous dysfunction - caused by reflux, obstruction or a combination of these factors.

Predisposing factors for the development of varicose veins of the legs during pregnancy include:

Compression of the inferior vena cava and iliac veins by the pregnant uterus;

Increased venous pressure;

Slowing of blood flow in the vessels of the legs.

The occurrence of varicose veins of the legs during pregnancy is facilitated by:

Weakness of the vascular wall as a result of disruption of the structure and function of connective tissue and smooth

Damage to the endothelium and valve apparatus of veins;

The history of pregnant women with varicose veins of the lower extremities most often includes:

Violation of fat metabolism;

Disorders of the blood coagulation system;

Long-term use of oral contraceptives;

Prolonged bed rest.

Inspection and palpation of varicose, deep and main veins of the legs.

Determination of the state of the blood coagulation system at 16–18 weeks, 28–30 weeks, 36–38 weeks, including:

Soluble complexes of fibrin monomers;

To diagnose the condition of leg veins in pregnant women, the following instrumental research methods are used:

G the size of the lumen of the main venous vessels;

G vein patency;

G to assess the patency of deep veins;

G to detect the presence and location of blood clots;

G to identify areas of reflux in perforating veins and anastomoses.

Differential diagnosis is carried out with the following diseases:

Acute deep vein thrombosis of the legs;

Chronic arterial insufficiency.

Osteoarthritis and polyarthritis.

In case of severe varicose veins and the development of complications, consultation with a vascular surgeon or

Prevent the development of thromboembolic complications.

INDICATIONS FOR HOSPITALIZATION

Hospitalization is carried out with the development of:

Deep vein thrombosis,

Use compression hosiery of I–II compression class (elastic bandages, stockings or tights) daily during pregnancy, childbirth and the postpartum period.

As part of drug treatment, one of the drugs is prescribed:

Aescusan orally, 12–15 drops 3 times a day.

Glivenol orally in capsules 400 mg 2 times a day.

Venoruton orally in the form of capsules 300 mg 3 times a day with meals.

Troxevasin orally in the form of capsules 300 mg 3 times a day.

Detralex orally, 1 tablet 2 times a day.

For symptoms of hypercoagulation and disseminated intravascular coagulation, the following anticoagulants are used:

Heparin subcutaneously 5000–10000 units per day, 3–5 days.

Fraxiparine 2850 IU (0.3 ml in a syringe) per day, up to 5–7 days.

Fragmin 2500–5000 IU (0.2 ml in a syringe) per day, up to 5–7 days.

Antiplatelet agents are also used in treatment:

Dipyridamole orally at a dose of 25 mg 1 hour before meals 2-3 times a day.

Acetylsalicylic acid 60–80 mg per day at a time.

Surgical treatment is carried out in case of development of thromboembolic complications (deep vein thrombosis,

thrombophlebitis proximal to the upper third of the thigh).

TIMELINES AND METHODS OF DELIVERY

The method of delivery depends on the obstetric situation. Preferable delivery through the natural birth canal. During childbirth, the use of elastic compression (leg bandaging, stockings) is mandatory. 2 hours before the birth of the child, regardless of the method of delivery, it is advisable to administer 5000 units of heparin.

ASSESSMENT OF TREATMENT EFFECTIVENESS

To assess the effectiveness of treatment, Doppler sonography and angioscanning are used to determine the nature of the venous blood flow of the lower extremities.

The prognosis for life is favorable.

THROMBOPHLEBITIS OF SUPERFICIAL VEINS

Thrombophlebitis is a disease of the veins, characterized by inflammation of their walls and thrombosis.

O22.2 Superficial thrombophlebitis during pregnancy.

A pregnant woman complains of moderate pain when walking. Along the vein, a painful dense infiltrate in the form of a cord is palpated. Above the infiltrate there is hyperemia of the skin and thickening of the subcutaneous fatty tissue. The body temperature rises to low-grade levels, and the pulse quickens.

Diagnosis of thrombophlebitis of the superficial veins is based on an assessment of complaints and anamnesis, the results of a clinical examination, data from laboratory and instrumental studies.

The history of a pregnant woman with thrombophlebitis of the superficial veins most often includes:

A profession that requires long periods of standing;

Violation of fat metabolism;

Disorders of the blood coagulation system;

Long-term use of combined oral contraceptives;

Complications of pregnancy (preeclampsia, anemia);

Prolonged bed rest.

The superficial veins of the legs are examined and palpated.

A general blood test is performed, which reveals moderate leukocytosis with a shift of the leukocyte formula to the left, the ESR is slightly increased. The state of the coagulation system is determined and the following indicators are assessed:

Ultrasound examination of leg veins with determination of:

G the size of the lumen of the venous vessels;

G vein patency;

G nature of venous blood flow;

G presence or absence of reflux.

G to assess venous patency;

G to determine the consistency of the valve apparatus;

G to detect the presence and location of blood clots.

If the results of this study are negative, and the clinical picture does not allow deep vein thrombosis to be excluded, then venography is performed.

INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS

Before starting treatment, it is advisable to consult with a vascular surgeon to decide on the possible hospitalization of the pregnant woman in the appropriate department of a multidisciplinary hospital.

EXAMPLE OF FORMULATION OF DIAGNOSIS

Pregnancy 32 weeks. Thrombophlebitis of the superficial veins of the right leg.

Restoration of venous outflow of blood in the superficial veins of the lower extremities.

In the presence of thrombosis in the lower leg and lower third of the thigh, cold is prescribed as local therapy for the first 2-3 days, ointment applications (ointments with sodium heparin, troxerutin or phenylbutazone), elastic compression of the legs and their elevated position.

As drug therapy, phenylbutazone 0.15 g orally three times a day with or after meals, rheopirin 5 ml intramuscularly, xanthinol nicotinate 0.15 g orally three times a day, acetylsalicylic acid orally 0.125 g per day are used. diphenhydramine 0.05 g orally or other antihistamines (promethazine 0.025 g orally, chloropyramine 0.025 g orally, clemastine 0.001 g orally twice a day). To improve microcirculation and provide a phlebodynamic effect, use troxerutin 5 ml of a 10% solution intramuscularly or 0.3 g three times a day orally, escin 12-15 drops before meals three times a day. In case of severe thromboembolic complications in the anamnesis, as well as in case of pathological hypercoagulation confirmed by hemostasiogram, it is possible to prescribe sodium heparin 2500–5000 IU subcutaneously or low molecular weight heparins (nadroparin calcium, enoxaparin sodium, dalteparin sodium) 1–2 times a day subcutaneously under the control of the coagulation state blood systems. According to current international recommendations, low molecular weight heparins are the drugs of choice for pregnant women, taking into account their effectiveness and safety compared to unfractionated heparin.

In the case of ascending thrombophlebitis of the great saphenous vein, due to the risk of thromboembolism, ligation of the great saphenous vein of the thigh should be performed in the area where it flows into the femoral vein (Troyanov-Trendelenburg operation).

INDICATIONS FOR HOSPITALIZATION

Hospitalization is indicated in the presence of superficial vein thrombophlebitis and the development of associated complications, including ascending thrombophlebitis of the great saphenous vein, deep vein thrombosis, and pulmonary embolism.

ASSESSMENT OF TREATMENT EFFECTIVENESS

The criterion for the effectiveness of treatment is the restoration of blood flow through the affected vessels, which is determined using Doppler measurements.

CHOICE OF DATE AND METHOD OF DELIVERY

If there is an effect from the treatment of thrombophlebitis of the superficial veins of the lower extremities, in the absence of other contraindications and with an appropriate obstetric situation, vaginal delivery is possible

birth canal. Management of childbirth does not differ from that during the physiological course of pregnancy. During childbirth and the postpartum period, elastic compression of the legs (leg bandaging, stockings) is used. 2 hours before the baby is born, it is advisable to administer 5000 units of heparin or low molecular weight heparin.

code icd-10

The Moscow Center for the International Classification of Diseases, collaborating with the West, took a direct part in the preparation of the next 10th revision of B, using in this work the experience of specialists from the leading clinical institutes and their proposals for adapting this international document to the practice of medical institutions in Russia. B has become the international standard diagnostic for all general epidemiological purposes and many health management purposes. You can help the project by adding to it. The letter U is left vacant as a reserve. Thus, possible code numbers extend from A00. In both cases, the primary location is considered unknown. Consciousness and the ability to concentrate are also often reduced, but obvious impairment of intelligence and memory does not always occur. Four-Digit Subcategories Most three-character categories are subdivided by the fourth digit after the decimal point to allow for up to 10 additional subcategories. The direction of changes usually depends on the nature of the personality before the disease. In the Russian Federation, B has another specific goal.

According to the ICD-10 code for expanding self-financing, its users have a natural concern about the ICD-10 code in the process of its revision. Factory B Periodic sleeves B, looking at the Ninth revision in Shatuny The classification is divided into 21 supervision.

When used in combination with inducers of liver microsomal conjectures, phenobarbital, carbamazepine, phenytoin, rifampicin, ICD-10 code, nevirapine, zfavirenz intensifies the metabolism of the genital organs, which can lead to a decrease in the flow of the drug.

In two cases, the primary location is considered unknown. ICD-10 code Four subscriptions I, II, XIX and ICD-10 code more than one woman in the first character of their codes. Sabers C76-C80 include court neoplasms code ICD-10 ill-defined by x-ray localization or those divided as code ICD-10 or spread without collision to the primary location.

Russian resistance B-10 prof. The effect of semisynthetic penicillins and chloramphenicol wears off.

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 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.

Deep vein thrombosis of the lower extremities: Causes

Etiology

Trauma Venous stasis caused by obesity, pregnancy, pelvic tumors, prolonged bed rest Bacterial infection Postpartum period Taking oral contraceptives Oncological diseases (especially cancer of the lungs, stomach, pancreas) DIC.

Pathomorphology

A “red” thrombus, formed during a sharp slowdown in blood flow, consists of red blood cells, a small amount of platelets and fibrin, attached to the vascular wall at one end of the thrombus, its proximal end floating freely in the lumen of the vessel. The most important feature of thrombus formation is the progression of the process: blood clots reach a large extent along the length of the vessel The head of the thrombus, as a rule, is fixed at the valve of the vein, and its tail fills all or most of its large branches. In the first 3–4 days, the thrombus is weakly fixed to the wall of the vessel; detachment of the thrombus and pulmonary embolism is possible. After 5–6 days, inflammation occurs the inner lining of the vessel, facilitating the fixation of the blood clot.

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 thrombosis of the pelvic veins, mild peritoneal symptoms and sometimes dynamic intestinal obstruction are observed.

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

Cellulitis Rupture of a synovial cyst (Baker's cyst) Lymphatic edema (lymphedema) Compression of a vein from the outside by a tumor or enlarged lymph nodes Stretching or rupture of muscles.

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 of the 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 of the great saphenous vein, perforating vessels, and 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.

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 a dangerous disease, requires certain efforts from the patient and perseverance of the doctor.

Phlebitis and thrombophlebitis (I80)

Included:

endophlebitis
inflammation of the veins
periphlebitis
purulent phlebitis

If it is necessary to identify the drug whose use caused the injury, use an additional external cause code (class XX).

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 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.

International disease code

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.

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

Deep vein thrombosis of the lower extremities

Deep vein thrombosis of the lower extremities: Brief description

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.

With thrombosis of the pelvic veins, mild peritoneal symptoms and sometimes dynamic intestinal obstruction are observed.

Deep vein thrombosis of the lower extremities: Diagnosis

Differential diagnosis

Deep vein thrombosis of the lower extremities: Treatment methods

Treatment

Mode

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 of 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 saphenofemoral junction, which caused a large number of 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 for a long time, then the leukocytes are firmly fixed to the 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, blood cells (erythrocytes, leukocytes) penetrate into the subcutaneous tissue. Lipodermatosclerosis and hyperpigmentation occur. With further persistence and deepening of disturbances in microcirculation and blood stasis, the death of skin cells occurs 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 the initial stages of the disease, few and very nonspecific symptoms appear. Patients are concerned about 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 whole symptom complex differs so much from patient to patient that practically the only successful name for it should be recognized as “heavy legs syndrome” (not to be confused with “restless legs syndrome”). The presence of this syndrome does not necessarily predispose to subsequent varicose vein transformation. However, the majority of patients with varicose veins of the lower extremities at the onset of the disease noted any of the listed symptoms. 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 supportive measures.
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 possible only by surgical methods. People with risk factors and a hereditary predisposition to varicose veins need to consult a phlebologist once every 2 years with a mandatory ultrasound examination of the veins.

Surgical methods

Phlebectomy

Phlebectomy is a surgical procedure to remove 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. It is used as the primary treatment when surgery is not possible. 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, elastic bandages and compression hosiery are most often used for compression treatment. 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, a correct lifestyle is important.

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 of the abdominal aorta, iliac and femoral arteries, popliteal cysts, and the 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 the clinical course of acute ileofemoral thrombosis, a prodromal stage and a stage of pronounced clinical manifestations are distinguished. 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 occurs when there is almost complete disruption of the 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 frequency 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 the jugular vein or 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 for 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 opening in the femoral vein is not always feasible due to its compression by the right iliac artery, the presence of intravascular septa and adhesions 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 a closed method of operation or application of a provisional tourniquet to the vena cava with an 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;
presence of a chemical within 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 of the condition of the blood vessels.

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, congenital heart defects, 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.

The disease has thrombophlebitis of the lower extremities, the ICD-10 code is I80.0. ICD-10 is an international classification of diseases. Thrombophlebitis is a disease in which inflammation of the inner wall of a vein occurs with the formation of a blood clot.

Causes and signs of the disease

Acute deep vein thrombosis can occur for various reasons. Doctors say the disease sometimes progresses after intravenous infusion or surgery. In addition, thrombophlebitis may occur due to disruption of the normal blood flow in the veins. In some cases, this disease is a complication of varicose veins.

Numerous medical studies have proven that thrombophlebitis can occur due to increased levels of estrogen. For example, this happens during pregnancy or long-term use of hormonal drugs.

Sometimes this disease progresses due to insufficient synthesis of heparin. With vasculitis, periarthritis and Buerger's disease, the risk of thrombophlebitis increases by 30-40%. In addition, smoking, addiction to alcoholic beverages, injuries, diseases of the cardiovascular system and obesity can also cause the progression of the disease.

Symptoms of the disease do not appear immediately. However, over time, the patient may experience heaviness in the legs. Often in the area of the lower extremities, swelling and redness of the skin occurs at the site of the affected vessel. During an exacerbation, the patient experiences severe pain in the affected area. Pain increases significantly with physical activity. The skin takes on a bluish tint, and body temperature rises sharply (up to 39°C). Upon palpation, compactions can be detected in the vein. In addition, swelling may appear in the affected area.

Diagnostic and preventive measures

When characteristic symptoms appear, the patient is prescribed a comprehensive diagnosis. First of all, the doctor must conduct a visual examination. At the same time, he pays attention to skin color and vascular nodules. After this, the patient is prescribed laboratory diagnostics. It includes a general blood test, coagulogram, thromboelastogram, tests for prothrombin index and C-reactive protein. Sometimes the examination is supplemented with instrumental diagnostics. It includes ultrasound, duplex scanning, venography, phlebomanometry. The most effective procedure among those listed is duplex scanning. This method allows you to identify the location of thrombosis. In addition, duplex scanning can determine the condition of the venous valve.

To prevent the development of thrombophlebitis, doctors advise regularly taking preventive measures. First of all, you need to give up bad habits. It is also advisable to avoid physical inactivity. Experts note that the load on the legs should be reasonable. Static vertical loading should be avoided. It is very important to watch your diet. It is advisable to exclude from the menu foods that can lead to the development of various venous diseases. These products include fatty foods, processed foods, flour products, sweets, carbonated and alcoholic drinks. It is advisable to give preference to foods high in fiber, fresh vegetables and cereals. In addition, you need to drink enough liquid. Doctors recommend drinking at least 2-3 liters of water per day. It is very important to maintain emotional stability, since in 30% of cases various diseases appear due to stress.

Therapeutic measures

Before prescribing the optimal treatment methods, the physician must familiarize himself with the patient's medical history. In addition, the attending physician must take into account the severity of the disease and the individual characteristics of the patient.

Most often, thrombophlebitis is treated with drug therapy. Direct anticoagulants are predominantly used. These medications help prevent blood clots. If the patient has affected saphenous veins, the drugs are administered by injection. Heparin, Enoxaparin or Hemapaxan are suitable for these purposes. To thin the blood, doctors may resort to using Aspirin.

Treatment is supplemented with special ointments. Mostly they use products that contain heparin. As a rule, ointments are used within a week. Diclofenac and Ketonal are considered a good remedy for combating thrombophlebitis. To relieve swelling, preparations based on rutin are ideal. For example, you can use Venoruton, Troxevasin or Troxerutin.

Lyoton-1000 ointment has a good effect. This remedy helps relieve swelling and prevent the formation of blood clots. As an alternative, you can use “Venen”. This ointment is made on a plant basis. “Venen” helps relieve swelling and eliminate inflammation. If pathogenic bacteria are found in the patient's blood, doctors prescribe antibiotics. As a rule, the patient is administered Cephalexin or Ceftriaxone. After stopping the acute period of the disease, doctors can resort to using elastic bandages. In order to eliminate inflammation, the patient may be prescribed drugs with antihistamine activity. Therapeutic measures are supplemented with physiotherapy and exercise therapy. Sometimes doctors resort to hirudotherapy or the use of homeopathic medications.

If drug therapy does not help, doctors resort to surgery. Surgery is prescribed only if the risk of blood clot rupture is high. In addition, surgery is prescribed if the blood clot begins to fester.

Thrombophlebitis, a common and dangerous disease, is classified by ICD 10 as a disease of the circulatory system. A blood clot forms inside the inflamed vein, disrupting blood flow. In 70% of cases, the disease develops in the lower extremities.

Factors of occurrence

The causes that provoke the development of the disease (ICD code 10 I 80) are divided into 3 factors:

Thickening of the blood due to changes in its composition.
Reducing the speed of blood flow.
Damage to the inner lining of blood vessels.

These factors are diagnosed individually or in combination. They contribute to the development of varicose veins, which is the cause of acute thrombophlebitis.

Vein thrombosis is a rather dangerous disease that can be fatal if a blood clot breaks off and enters the arteries of the lung or heart.

Thrombophlebitis (ICD code 10 I80) develops with forced immobility of a limb (with a fracture).

Thrombosis of the veins of the lower extremities is caused by taking estrogen-containing hormones prescribed for infectious and autoimmune diseases. Oncological diseases provoke thrombophlebitis of the lower extremities. Installation and long-term presence of a catheter in the venous bed and frequent injury to the walls by injections lead to the formation of blood clots.

In 65% of cases, thrombophlebitis is diagnosed in women. The pattern is associated with wearing high-heeled shoes, tight jeans and taking hormonal contraceptives. The cause of the disease may be pregnancy. During this period, physiological activation of coagulation processes occurs, preventing bleeding in the postpartum period, and the inflamed vessel wall leads to the formation of a blood clot. People aged 40-55 years are at risk. At this age, the condition of the body's vascular system deteriorates significantly.

Thrombosis is hereditary. Causative factors include obesity, unbalanced diet, physical activity, smoking and drinking alcoholic beverages.

Deep vein thrombosis has a specific code in the ICD-10 classification – I80

Classification of the disease

ICD 10 code I80 includes phlebitis and thrombophlebitis. Symptoms vary depending on the location of the clot. There are 2 types of diseases:

surface;
deep.

Superficial thrombophlebitis develops in the great saphenous vein. It is easy to diagnose. Inflammatory changes occur in the area of the affected vessel, but if dilatation of the veins is not observed, then ICD 10 interprets thrombophlebitis as a complication of gynecological pathology or a symptom of a malignant tumor in the organs of the digestive system. Thrombophlebitis ICD 10 also includes thrombosis in the intestine.

When palpating the inflamed saphenous vein, the patient experiences stabbing pain. Symptoms of superficial thrombophlebitis: scarlet stripes on the skin, swelling of the ankles and feet, increased body temperature.

Without treatment, thrombosis spreads to the deep veins. The patient's health worsens. Infiltration and hyperemia are observed in the area of the thrombosed vessel.

There are 2 types of thrombosis that require special attention:

Ileofemoral thrombosis- a subtype of deep vein thrombophlebitis. The disease affects large vessels in the femoral and iliac veins. If blocked, it can be fatal. Ileofemoral thrombosis develops rapidly. The patient develops severe swelling of the lower extremities. High body temperature is added to the symptoms. The skin acquires a bluish tint. Complete blockage can lead to the development of gangrene.

Such an acute inflammatory process of the lower extremities is dangerous for human life, and ignoring it can lead to death

Thrombosis of mesenteric vessels- blockage of the mesentery or mesentery. Without treatment, thrombosis of the mesenteric vessels leads to the death of the affected area. Mesenteric thrombosis (code K55 in ICD 10) requires immediate surgical intervention.

Symptoms

Thrombosis of the lower extremities according to the clinical picture is classified into:

Spicy. Symptoms of the acute form appear suddenly. The patient experiences muscle pain along the thrombosed vessel. Acute thrombosis is accompanied by elevated body temperature. Red stripes appear on the skin. Deep vein thrombophlebitis differs from superficial thrombophlebitis in severe swelling, heaviness in the legs and bluish skin. The pain intensifies, causing lameness.
Chronic. With this form, blood clots may dissolve or enlarge. Chronic deep vein thrombophlebitis has a sluggish nature. The patient may experience pain only upon palpation.

The main factors that can provoke deep vein thrombophlebitis are: tissue nutritional disorders and the development of aseptic inflammation

When the inferior vena cava is blocked, bilateral swelling of the limb is observed. If the thrombus is located in the iliac segment, then unilateral edema is noted. When walking for a long time, aching pain appears in the calf muscle.

Thrombosis is manifested by numbness of the limbs, loss of sensitivity, tingling of the skin, chills and hardening of the lymph nodes. The first symptoms of the chronic form may appear a year after the exacerbation. The disease can be migratory in nature. This form is characterized by rapid development. The migratory form affects the superficial veins. Dense thrombosed nodules can change their position, appearing in different parts of the limb. Seals are accompanied by swelling and increased body temperature.

Treatment

For thrombophlebitis, doctors prescribe treatment based on the diagnostic results obtained. Treatment includes:

drug therapy;
surgical intervention.

Thrombophlebitis has several forms: acute and chronic

If thrombosis affects the superficial veins, then treatment is carried out with medication. The patient is prescribed phlebotonics, anti-inflammatory drugs, ointments. Conservative treatment relieves swelling, reduces pain and restores blood flow. Anti-inflammatory drugs include drugs such as Ibuprofen, Aspirin and Diclofenac. “Heparin ointment” and “Troxevasin” have a local effect.

For thrombosis of superficial veins, doctors prescribe electrophoresis with anticoagulants, UHF therapy and magnetic therapy. Physiotherapeutic procedures dissolve blood clots and reduce swelling and pain.

Conservative treatment is carried out in combination with compression therapy. For thrombophlebitis, elastic bandages and compression stockings (stockings or tights) should be worn. The degree and class of compression is prescribed by a phlebologist depending on the severity of the disease.

For superficial thrombophlebitis, treatment with folk remedies is effective. Verbena leaves will help eliminate swelling, heaviness and relieve pain in the legs. Pour 20 g of leaves into 200 ml of boiling water. Take the drink 100 ml 3 times a day during the day.

Deep vein thrombosis of the lower extremities requires a radical method of treatment. Depending on the stage and nature of the disease, the method of surgical intervention is chosen. The endoscopic procedure is a low-traumatic method of treatment. During the procedure, the vessel is “sealed” above the site of phlebitis. In modern medicine, radiofrequency obliteration and laser coagulation are used. Minimally invasive methods do not cause complications and are carried out even during pregnancy. Due to the low-traumatic nature of the operations, the rehabilitation period is minimal. As the disease progresses, the thrombosed vessel is completely removed. In case of deep venous thrombosis, elastic compression is prohibited. Bandaging leads to the development of complications.