ULTRASOUND DETERMINATION OF TOTAL ARTERIAL-WALL THICKNESS

Purpose: Ultrasonic measurement techniques for determining intima-media thickness and total arterial wall thickness have been described. The intima-media thickness measurements are currently in use in large epidemiologic trials. Intima-media thickness does not evaluate extramedial atherosclerotic change and so may not fully reflect pathologic changes in the arterial wall. Methods: After we performed variability studies of B-mode image acquisition and measurement, we measured total wall thickness and intima-media thickness of the common carotid arteries in 60 adult subjects in three groups: a control group aged 20 to 29 years, a control group aged 60 to 79 years, and a claudication group aged 60 to 79 years. Measurements were made with B-mode ultrasound images. Results: No statistical difference between sexes was noted. A statistically significant (p less than or equal to 0.05) increase in intima-media thickness and wall thickness was found with increasing age, and an additional increase was observed with clinically significant lower extremity arterial occlusive disease (p less than or equal to 0.05). Image quality had an effect on measurement accuracy. Conclusions: The finding that the wall thickness of common carotid arteries is increased in those patients with clinically significant lower extremity disease supports the theory that atherosclerosis affects the arterial wall in a systemic fashion. Because intima-media thickness also increases across subject groups without change in its proportional contribution to the total arterial wall thickness, extramedial arterial changes also occur with aging and the development of atherosclerosis. We propose that because increases in wall thickness measurements of common carotid arteries follow intima-media thickness increases (but do not necessarily measure the same physiologic change) and the wall thickness method can be used in cases when the intima-media thickness cannot be measured, arterial Nail thickness measurement may serve as an alternate or confirmatory test of peripheral artery atherosclerotic severity.