One hundred and thirty-four families were examined: 67 patients and their parents and 67 controls and their parents. A total of 402 subjects were examined. The results demonstrated a prominent role of heredity in the development of varicose veins (P < .001). The risk of developing varicose veins for the children was 90% when both parents suffered from this disease, 25% for males and 62% for females when one parent was affected, and 20% when neither parent was affected.

An international consensus meeting to determine criteria for the characterization of extracranial carotid artery stenosis was held in Paris on December 13–14, 1996. Recommendations are the following if the degree of the stenosis and the precise location of the stenosis are well defined. Ultrasonic Doppler duplex methods describe the composition and the surface topography of carotid plaques. Echogenicity (from anechoic to hyperechoic), surface (from smooth to cavitated) and texture (from homogeneous to heterogeneous) are the features to be estimated as plaque thickness and length. Echogenicity is standardized against blood (anechoic), mastoid muscle (isoechogenic) or bone (hyperechogenic cervical vertebrae). Luminal surface is classified into three classes: regular, irregular (0.4–2 mm depth) and ulcerated (>2 mm depth with a well-defined back wall at its base and a color Doppler injection). Texture is a function of pixle size and, in a given region of interest, reflects the variability of the grey scale values. Recommended technical requirements are frequency- and amplitude-modulated color Doppler flow imaging, carrier frequency >5 MHz capable of insonating up to 4 cm and retrievable documentation of relevant findings. Computed tomographic angiography permits three-dimensional rendering of the size and extent of the plaque and allows to recognize calcifications, deposits, plaque isodense to muscle and ulcers >2 mm in size. Angiography may identify gross calcifications and large ulcers defined in two classes: 1 – large (2 mm depth by 2 mm width) and 2 – complex with multiple craters. Magnetic resonance imaging with or without angiography may play a role in the future. In vitro studies show that MR can demonstrate plaque components such as fibrosis, calcification, hemorrhage and necrotic core, but current technical limitations related to resolution and motion artifacts prevent this from being implemented in vivo. Pathological studies require en bloc surgery. Component areas should be calculated from their length and width, and ulcerations measured from their width. The risk of cerebrovascular ischemia is clearly related to the degree of stenosis. Factors of individual importance for higher risk include in descending importance: evidence of progression, surface ulceration and low echogenicity. Texture is still under investigation as a prognostic factor.

Background and Purpose: Echolucent carotid plaques compared with echogenic plaques could carry a significant risk of transient ischemic attacks and strokes, but the reproducibility of new ultrasonic methods has not yet been proved. The objective was to evaluate interobserver and intraobserver agreement in characterizing the carotid plaques studied by both B mode imaging and color Doppler imaging, which is the only ultrasonic method available for recognizing anechoic lesions. Methods: Fifty-three carotid plaques greater than 40% in diameter were selected from four centers and simultaneously analyzed by 9 observers. Five types of plaques were defined by their echo structure: class I = uniformly anechogenic, class II = predominantly hypoechogenic with >50% hypoechogenic area, class III = predominantly echogenic with >50% echogenic area, class IV = uniformly echogenic, class V = unclassified plaques. The luminal surface was characterized as either 1 = regular, 2 = recess of more than 2 mm in depth and width, or 3 = unclassified. Agreement of these variables was calculated by using the kappa index, agreement proportion and an intraclass correlation coefficient. Results: Interobserver reproducibility was only fair for type I (kappa = 0.47) and for the luminal surface (class 1, kappa = 0.52 and class 2, kappa = 0.41). Agreement proportion was 0.51 in hypoechoic plaques and 0.64 in the determination of the regular surface. Mean intraobserver agreement was fair (kappa = 0.47 ± 0.1) for plaque echogenicity to good (kappa = 0.63 ± 0.19) for surface. Conclusion: This study shows that the semiquantitative classification, first developed by Gray-Weale, then by Nicolaides, could be improved, thus giving rise to a new outlook in the debated field of ulcerations.

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