The diagnostic potential of color-coded duplex sonography in extracranial vascular lesions is evaluated with reference to the literature. Indications for the applications of color-coded duplex sonography comprise congenital vascular anomalies, arteriosclerotic lesions, dissections, aneurysms, arteriovenous fistulas and glomus tumors. New applications consist include monitoring after vascular interventional procedures. Color-coded duplex sonography allows recognition of congenital anatomic variants like agenesis of the internal carotid artery and variations of the origin of the vertebral artery. By superior surface delineation, characterization and quantification of plaques and stenoses are improved because of a new development in ultrasound technique. In cases of vessel dissection color-coded ultrasound is able to depict the dissection membrane, pulse synchronous flow reversal and "reentry" phenomena. Significant carotid bulb ectasia can be demonstrated and differentiated from aneurysm formation by 3D technique and angio-CT. Extracranial arteriovenous fistulas may be localized and detailed with respect to feeding arteries and draining veins. Glomus caroticum and jugular tumors are characterized by a high degree of vascularity and a position in the carotid bifurcation and within the jugular vein, respectively. The position of intravascular devices like detachable balloons and catheters was precisely demonstrated. CONCLUSIONS Color-coded duplex sonography may assume a leading role in the noninvasive evaluation of extracranial vascular lesions. It provides criteria for the necessity and rational application of additional diagnostic procedures (MR, MRA, CT, DSA).