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41, 95% CI 0.15-1.13, P = .085). There is a lower risk of periprocedural adverse events (RR 0.81, 95% CI 0.70-0.94, P = .006) and vascular complications (RR 0.81, 95% CI 0.68-0.96, P = .013) in the IVUS group. All-cause mortality (RR 0.76, 95% CI 0.56-1.04, P = .084), amputation rates (RR 0.83, 95% CI 0.32-2.15, P = .705), myocardial infarctions (RR 1.19, 95% CI 0.58-2.41, P = .637), and technical success (RR 1.01, 95% CI 0.86-1.19, P = .886) were similar between the groups. CONCLUSIONS Intravascular ultrasound-guided PVIs had similar