# Intravascular imaging in peripheral arterial disease: a contemporary literature review

## TL;DR

This paper reviews how intravascular imaging technologies like IVUS and OCT can improve diagnosis and treatment of peripheral arterial disease compared to traditional methods.

## Contribution

The paper provides a contemporary review of IVUS and OCT applications in peripheral arterial disease, highlighting their advantages and limitations.

## Key findings

- IVUS and OCT improve lesion assessment and stent implantation compared to angiography alone.
- OCT offers higher resolution for detailed lesion morphology but has limitations like reduced penetration depth.
- Both imaging modalities are associated with better vessel patency and lower reintervention rates.

## Abstract

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.