High resolution ultrasound can be used for the accurate measurement of intima-media thickness (IMT). The within-observer coefficient of variation of the IMT of two carotids measured seven times each on different days by two different observers was between 4% and 8%, and the mean absolute difference of the IMT of 68 carotids measured independently by two observers was 0.11 +/- 0.11 mm (mean value +/- SD). Seventy-five consecutive male patients who underwent coronary angiography for assessment of chest pain and 40 normal controls matched for age and sex, were examined with high resolution B-mode ultrasound. The IMT of the common carotid artery for the controls was 0.71 +/- 0.16 mm and for the patients 0.91 +/- 0.18 mm (P < 0.005). In patients with normal coronary angiogram the IMT was 0.73 +/- 0.1 mm, and this increased in each of the subgroups with coronary stenosis compared to patients who had a normal coronary angiogram. In the group with one-vessel disease it was 0.91 +/- 0.17 mm (P < 0.05, ANOVA), in the group with two-vessel disease it was 0.96 +/- 0.17 mm (P < 0.01), and in the group with three-vessel disease it was 0.99 +/- 0.21 mm (P < 0.01). There was a significant linear trend between IMT and the number of involved vessels (P < 0.0001, r = 0.44). An IMT > or = 0.85 mm was derived from the studied population of 75 patients as a criterion for the prediction of coronary artery disease (CAD).(ABSTRACT TRUNCATED AT 250 WORDS)

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Atherosclerosis constitutes the most common medical and surgical problem. This can be manifested clinically as stroke, coronary artery disease, or peripheral vascular disease. In the present review the microscopic appearance of the normal arterial wall, the definition of atherosclerosis and the five theories of atherogenesis are described. These are: the lipid theory, the hemodynamic theory, the fibrin incrustation theory, the nonspecific mesenchymal hypothesis and the response to injury hypothesis. Based on the above theories the sequence of events in atherogenesis is analyzed. The classification of the atherosclerotic lesions according to Stary (types I-VI) and their characteristics appear in a table. The epidemiology and the role of the following risk factors are presented in detail: age, sex, lipid abnormalities, cigarette smoking, hypertension, diabetes mellitus, physical inactivity, alcohol consumption, obesity, and hemostatic factors. In addition, less common genetically determined associations like homocystinuria, Tangier disease, Hutchinson-Gilford syndrome (progeria), Werner's syndrome, radiation induced atherosclerosis and the implications of Chlamydia pneumoniae on the arterial wall are discussed.

In addition to an increase in diameter, perforator incompetence is characterized by significantly higher mean and peak flow velocities, volume flow, and venous volume displaced outward, and a lower flow pulsatility. Differences in early reflux enable a better hemodynamic stratification of incompetent perforators in CVI classes. In the presence of deep reflux, incompetent perforators sustain further hemodynamic impairment. In situ hemodynamics enable quantification of the function of perforators and can be used in the identification of the clinically relevant perforators and the impact of surgery.

UGFS is 3.15 times less expensive than EVLA (£230.24 vs £724.72) with comparable effectiveness but 56% (versus 6%) required additional foam (ISRCTN:03080206).