Introduction: This study evaluates the role of cone-beam ct in endovascular procedures in contemporary surgical practice, assessing its impact on clinical outcomes, procedural accuracy, and patient safety in a prospective comparative analysis. Materials and Methods: A prospective comparative study was conducted on 290 patients from April 2018 to March 2024 at a tertiary care center. Patients were divided into CBCT-assisted (n=145) and Conventional angiography (n=145) groups. Primary outcomes included procedural success rate, complication rates, and clinical efficacy measures. Results: The CBCT-assisted group demonstrated significantly improved primary outcomes compared to Conventional angiography (p<0.05). Complication rates were lower in the study group, and procedural efficiency was maintained or improved. Multivariate analysis confirmed the imaging modality as an independent predictor of favorable outcomes. Conclusion: The findings support the integration of advanced imaging guidance in surgical practice, demonstrating measurable improvements in accuracy, safety, and clinical outcomes that justify the investment in imaging technology.