Intravascular ultrasound (IVUS) has been around for 50 years now providing high-quality cross-sectional imaging of the vascular lumen and offering a detailed intraluminal view of the vessel. Most of the safety and effectiveness clinical data come from percutaneous coronary intervention (PCI) use, but the evidence in peripheral vascular intervention is strongly developing. Even though underused so far, it is slowly becoming an important element of peripheral artery disease (PAD) vascular interventions as more clinical evidence emerges.