Intravascular imaging in peripheral arterial disease: a contemporary literature review

Intravascular ultrasound and optical coherence tomography are advanced intravascular imaging modalities that provide detailed vessel assessment and have shown potential to optimize peripheral arterial disease interventions. While angiography remains the standard guidance tool during peripheral endovascular procedures, intravascular imaging offers superior visualization of lesion characteristics and vessel dimensions. This scoping review of the literature, conducted using MEDLINE and EMBASE from inception to 21 September 2025 and reported according to PRISMA-ScR recommendations, evaluates the technology, principles, and clinical applications of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in peripheral interventions. Compared with angiography alone, both modalities aid in lesion preparation, improve stent implantation, reduce procedural complications, and are associated with improved vessel patency and lower reintervention rates. Optical coherence tomography, owing to its higher resolution, is particularly useful for detailed lesion morphology assessment and identification of neointimal hyperplasia in in-stent restenosis, although its use is limited by reduced penetration depth, field of view, contrast requirements, and the need for blood clearance. Overall, IVUS and OCT facilitate precise vessel characterization and improved procedural outcomes in peripheral arterial disease, though further high-quality randomized studies are needed to define optimal indications and cost-effectiveness.