The increasing complexity of minimally invasive procedures requires a continuous improvement in imaging technologies that guide and monitor such procedures. Modern flat detector (FD)-C-arms with C-arm computed tomography (CT) technology combine 3D soft tissue imaging, 2D real time fluoroscopy, and high-resolution angiography without the need for transferring the patient to another imaging modality. The availability of C-Arm CT provides the potential to expand the range of procedures that can be performed in an angiography suite. Its benefits for interventional procedures have been demonstrated for a multitude of percutaneous and angiographic procedures. Nowadays, C-Arm CT is applied in manifold interventional procedures for planning and peri-interventional guidance of both, percutaneous punctures as well as endovascular procedures. C-Arm CT can significantly improve procedure guidance, thereby improving peri-procedural safety, therapeutic efficiency and overall outcome of percutaneous and vascular interventions. Moreover, it helps to avoid additional oblique DSA runs, thus reducing radiation exposure and the amount of contrast used during an interventional procedure.