K95 Varicose veins of leg (ICD-10:I83.9)

Introduction

Varicose veins of the leg, also known as varicosities, are enlarged and twisted veins that appear blue or dark purple. They usually occur in the legs and can cause discomfort, pain, and cosmetic concerns^[1]. The aim of this guide is to provide a comprehensive overview of varicose veins of the leg, including symptoms, causes, diagnostic steps, possible interventions, and lifestyle interventions.

Codes

• ICPC-2 Code: K95 Varicose veins of leg
• ICD-10 Code: I83.9 Varicose veins of lower extremities without ulcer or inflammation^[2]

Symptoms

• Visible, enlarged, and twisted veins
• Swelling in the legs, ankles, or feet
• Aching or throbbing pain in the legs
• Heaviness or fatigue in the legs
• Itching or irritated skin over the veins
• Muscle cramps or restless legs
• Skin discoloration or ulcers in severe cases^[3]

Causes

• Weak or damaged valves in the veins that prevent proper blood flow
• Increased pressure in the veins due to prolonged standing or sitting
• Hormonal changes during pregnancy or menopause
• Family history of varicose veins
• Obesity or excess weight
• Aging, as the veins lose elasticity^[4]

Diagnostic Steps

Medical History

• Gather information about the patient’s symptoms, including the duration and severity
• Identify any risk factors, such as family history, obesity, or hormonal changes
• Assess the impact of symptoms on the patient’s daily activities and quality of life^[5]

Physical Examination

• Inspect the legs for visible varicose veins and assess their size and severity
• Palpate the veins to check for tenderness or swelling
• Evaluate the patient’s leg strength and range of motion
• Assess for any skin changes or ulcers^[6]

Determine Severity

• Classify the severity of varicose veins based on the CEAP classification system:
  • C0: No visible or palpable signs of venous disease
  • C1: Telangiectasias or reticular veins
  • C2: Varicose veins
  • C3: Edema
  • C4: Skin changes (pigmentation, eczema)
  • C5: Healed venous ulcer
  • C6: Active venous ulcer^[7]

Laboratory Tests

• No specific laboratory tests are required for the diagnosis of varicose veins. However, in some cases, blood tests may be performed to rule out other conditions or assess overall health.

Diagnostic Imaging

• Duplex ultrasound: A non-invasive imaging technique that uses sound waves to visualize the veins and assess blood flow. It can help identify the location and extent of varicose veins.^[9]

Other Tests

• Venous reflux study: Measures the backward flow of blood in the veins to determine if there is venous insufficiency.
• Venogram: A dye is injected into the veins, and X-rays are taken to visualize the veins and identify any abnormalities.^[10]

Follow-up and Patient Education

• Schedule regular follow-up appointments to monitor the progression of varicose veins and assess the effectiveness of interventions.
• Educate the patient about self-care measures, such as wearing compression stockings, elevating the legs, and exercising regularly.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for varicose veins of the leg:

1. Compression stockings:
   • Cost: $20-$100 per pair.
   • Contraindications: Severe peripheral arterial disease, skin infections, or allergies to compression materials.
   • Side effects: Discomfort, skin irritation.
   • Severe side effects: Rare but can include skin breakdown or ulcers.
   • Drug interactions: None.
   • Warning: Proper fitting and usage instructions should be provided to the patient.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, naproxen):
   • Cost: Generic versions can be $5-$20 per month.
   • Contraindications: Active peptic ulcer disease, history of gastrointestinal bleeding, or allergy to NSAIDs.
   • Side effects: Upset stomach, heartburn.
   • Severe side effects: Gastrointestinal bleeding, kidney problems.
   • Drug interactions: Blood thinners, certain blood pressure medications.
   • Warning: NSAIDs should be used with caution in patients with kidney or heart disease.
3. Phlebotonics (e.g., diosmin, hesperidin):
   • Cost: $20-$50 per month.
   • Contraindications: None reported.
   • Side effects: Upset stomach, headache.
   • Severe side effects: None reported.
   • Drug interactions: None reported.
   • Warning: Phlebotonics may take several weeks to show noticeable improvement.
4. Topical creams or gels (e.g., horse chestnut extract, witch hazel):
   • Cost: $5-$20 per tube.
   • Contraindications: Allergy to the specific ingredient.
   • Side effects: Skin irritation, rash.
   • Severe side effects: None reported.
   • Drug interactions: None reported.
   • Warning: Topical creams or gels may provide temporary relief but are not a long-term solution.
5. Anticoagulants (e.g., heparin, warfarin):
   • Cost: Varies depending on the specific medication.
   • Contraindications: Active bleeding, history of bleeding disorders, or allergy to anticoagulants.
   • Side effects: Increased risk of bleeding.
   • Severe side effects: Severe bleeding, allergic reactions.
   • Drug interactions: Many medications can interact with anticoagulants.
   • Warning: Anticoagulants should be used under the supervision of a healthcare professional.

Alternative Drugs:

• Horse chestnut seed extract: May help reduce swelling and improve symptoms.
• Grape seed extract: Contains antioxidants that may improve blood flow and reduce inflammation.
• Butcher’s broom: May help strengthen blood vessels and reduce swelling.
• Gotu kola: May improve circulation and reduce symptoms of varicose veins.
• Pycnogenol: Derived from pine bark, it may have antioxidant and anti-inflammatory effects.

Surgical Procedures:

• Sclerotherapy: A chemical solution is injected into the affected veins, causing them to collapse and fade away. Cost: $300-$500 per session.
• Endovenous laser treatment (EVLT): A laser fiber is inserted into the vein, delivering laser energy to seal the vein. Cost: $1,500-$3,000 per treatment.
• Radiofrequency ablation: A catheter is inserted into the vein, and radiofrequency energy is used to heat and seal the vein. Cost: $1,500-$3,000 per treatment.
• Vein stripping: The affected vein is surgically removed through small incisions. Cost: $1,500-$3,000 per treatment.
• Ambulatory phlebectomy: Small incisions are made to remove the affected veins. Cost: $1,500-$3,000 per treatment.

Alternative Interventions

• Exercise: Regular physical activity, such as walking or swimming, can improve circulation and reduce symptoms. Cost: Varies depending on the chosen activity.
• Weight management: Losing excess weight can reduce pressure on the veins and improve symptoms. Cost: Varies depending on the chosen weight loss program.
• Elevating the legs: Raising the legs above heart level can help reduce swelling and improve blood flow. Cost: Free.
• Avoiding prolonged sitting or standing: Changing positions frequently and taking breaks can prevent blood from pooling in the legs. Cost: Free.
• Dietary changes: Consuming a diet rich in fiber, antioxidants, and omega-3 fatty acids may improve vein health. Cost: Varies depending on food choices.
• Herbal supplements: Some herbs, such as horse chestnut, may have potential benefits for reducing symptoms. Cost: Varies depending on the specific supplement.

Lifestyle Interventions

• Wearing compression stockings: These stockings apply pressure to the legs, improving blood flow and reducing symptoms. Cost: $20-$100 per pair.
• Elevating the legs: Raising the legs above heart level for 15-30 minutes several times a day can reduce swelling and discomfort. Cost: Free.
• Regular exercise: Engaging in low-impact exercises, such as walking or swimming, can improve circulation and strengthen leg muscles. Cost: Varies depending on the chosen activity.
• Weight management: Losing excess weight can reduce pressure on the veins and improve symptoms. Cost: Varies depending on the chosen weight loss program.
• Avoiding prolonged sitting or standing: Taking breaks and changing positions frequently can prevent blood from pooling in the legs. Cost: Free.
• Healthy diet: Consuming a diet rich in fiber, antioxidants, and omega-3 fatty acids may improve vein health. Cost: Varies depending on food choices.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – K95 Varicose veins of leg (ICD-10:I83.9)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Varicose veins of leg effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Varicose veins of leg. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Gloviczki, P., & Dalsing, M. C. (2018). Handbook of venous and lymphatic disorders: Guidelines of the American Venous Forum. CRC Press.
2. ICD-10 Code: I83.9 Varicose veins of lower extremities without ulcer or inflammation. (2021). ICD10data.com. https://www.icd10data.com/ICD10CM/Codes/I00-I99/I80-I89/I83-/I83.9
3. Eberhardt, R. T., & Raffetto, J. D. (2014). Chronic venous insufficiency. Circulation, 130(4), 333-346.
4. Beebe-Dimmer, J. L., Pfeifer, J. R., Engle, J. S., & Schottenfeld, D. (2005). The epidemiology of chronic venous insufficiency and varicose veins. Annals of epidemiology, 15(3), 175-184.
5. Meissner, M. H. (2016). What is the medical rationale for the treatment of varicose veins?. Phlebology, 31(1_suppl), 27-33.
6. Rabe, E., Breu, F. X., Cavezzi, A., Coleridge Smith, P., Frullini, A., Gillet, J. L., … & Pannier, F. (2014). European guidelines for sclerotherapy in chronic venous disorders. Phlebology, 29(6), 338-354.
7. Lurie, F., Passman, M., Meisner, M., Dalsing, M., Masuda, E., Welch, H., … & Wakefield, T. (2020). The 2020 update of the CEAP classification system and reporting standards. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 8(3), 342-352.
8. Rabe, E., & Pannier, F. (2010). Societal costs of chronic venous disease in CEAP C4, C5, C6 disease. Phlebology, 25(1_suppl), 64-67.
9. Coleridge-Smith, P., Labropoulos, N., Partsch, H., Myers, K., Nicolaides, A., & Cavezzi, A. (2006). Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs—UIP consensus document. Part I. Basic principles. European Journal of Vascular and Endovascular Surgery, 31(1), 83-92.
10. Min, R. J., Khilnani, N. M., & Golia, P. (2003). Duplex ultrasound evaluation of lower extremity venous insufficiency. Journal of vascular and interventional radiology, 14(10), 1233-1241.