This article examines how the hemodynamics of the normal and diseased carotid and vertebral arteries affect the waveforms obtained at ultrasound. The examination protocol and various techniques to optimize the gray-scale, color, and spectral Doppler images are discussed. Specific abnormal pathologies in the carotid and vertebral arteries are described. Resultant abnormal waveforms are illustrated and analyzed. © 2005 Elsevier Inc. All rights reserved.