Intravascular imaging has been increasingly incorporated into endovascular practice. The goal of this review is to explore the contemporary technologies used to perform intravascular imaging as well as the evidence supporting their use in the diagnostic assessment and treatment of peripheral vascular disease.

Although intravascular imaging has been more extensively studied in the coronary vasculature, there is a growing body of literature studying its use in other vascular territories. There are unique advantages and disadvantages for the two most commonly employed imaging modalities—intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Either may enhance the diagnostic capabilities of conventional angiography depending upon the clinical situation. IVUS and OCT guidance for angioplasty and stent sizing in peripheral interventions has been shown to be safe, feasible and in many instances, effective. Studies suggest that clinically relevant outcomes such as vessel primary patency and long-term patency may be improved by utilizing these imaging technologies.

While still employed as adjunctive modalities to angiography and peripheral intervention, IVUS or OCT may provide a potential pathway towards improving short- and long-term outcomes for a variety of vascular disease entities. At this time, further research is still warranted to better define the optimal role for these devices in non-coronary vascular beds.