The use of IVUS is well established in cardiology and is increasingly accepted as routine in deep venous endovascular interventions however, its application in peripheral artery endovascular interventions is far less common. This presentation will discuss the current evidence supporting the use of IVUS in the femoropopliteal arteries with a focus on the Flinders IVUS RCT and the Korean IVUS-DCB RCT – the only two studies providing high level evidence regarding the use of IVUS in these vessels- and how these studies can provide some guidance into how and when to use IVUS guidance. In addition, this presentation will provide practical guidance on the use and interpretation of IVUS imaging and discuss aspects of IVUS imaging that require further clarification.