Peripheral artery disease (PAD) affects more than 230 million people worldwide and remains a major cause of disability, limb loss, and cardiovascular morbidity. Endovascular interventions have become the preferred revascularization strategy for many peripheral arterial lesions. However, angiography alone often underestimates lesion severity, vessel size, plaque burden, and procedural complications. Intravascular imaging technologies such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) provide detailed cross-sectional visualization of vessel morphology and lesion characteristics.

Objective

To evaluate the clinical utility, procedural benefits, and outcomes associated with intravascular imaging during peripheral vascular interventions.

Methods

A multicenter retrospective observational study was conducted involving 420 patients undergoing peripheral endovascular intervention between January 2020 and December 2024. Outcomes of imaging-guided procedures were compared with angiography-guided interventions.

Results

IVUS-guided interventions demonstrated improved vessel sizing accuracy, higher procedural success rates, reduced stent restenosis, and lower target lesion revascularization rates compared with angiography-guided procedures. Imaging guidance significantly improved long-term patency and reduced adverse limb events.

Conclusion

Intravascular imaging has emerged as a valuable adjunct in peripheral interventions, improving procedural planning, device optimization, and long-term clinical outcomes.