This study is a retrospective analysis of the impact of intravascular ultrasound in addiction to conventional angiography in 36 patients with 55 stenotic peripheral arterial lesions treated with angioplasty and/or stenting. Before treatment, intravascular ultrasound imaging showed that the vessel diameter was underestimated with angiography in 6 cases. The correlation index between angiography and intravascular ultrasound measurements, however, was significant in 27 arterial lesions. After endovascular treatment, angiography showed 3 vessel dissections and no incomplete stent deployment, whereas intravascular ultrasound showed 15 dissections and 5 instances of stent underdeployment. If we consider the intravascular ultrasound data as the gold standard, the specificity of angiography is 100%, while its sensitivity is 56% for vessel dissection and 75% for stent deployment. In the follow up of the 16 patients treated for iliac lesions with intravascular ultrasound control, re-stenosis occurred in 5% (primary patency 94.7%); in a control group of 15 patients treated in the same period without intravascular ultrasound control, re-stenosis occurred in 15.8% (primary patency 83.4%, difference not statistically significant). In conclusion, in the peripheral arteries intravascular ultrasound is more accurate than arteriography in evaluating dissection and stent deployment, but the routine use of intravascular ultrasound in every case of iliac PTA or stenting would not appear justified.