Background: Lower limb peripheral arterial disease (PAD) is a common disease that affects about two hundred million peoples per year. It is the third leading cause of cardiovascular morbidity. We plan to evaluate the diagnostic performance of 64-section computed tomographic (CT) angiography in the assessment of steno-occlusive disease in patients with PAD, with conventional digital subtraction angiography (DSA) as the reference standard. Aim of study: is to compare the diagnostic accuracy of multidetector computed tomographic (MDCT) angiography in diagnosis of PAD compared to the DSA as pre-operative evaluation of lower limb peripheral arterial diseases. Patients and methods: The study included 20 patients clinically presented with symptomatic PAD from February 2018 to July 2018. The study protocol was approved, and written informed consent was obtained from all patients. The patients underwent CT angiography and subsequent DSA. For stenosis analysis (≥70% stenosis), the arterial bed was divided into 35 segments and evaluated by three readers. Inter observer agreement was determined with generalized κ statistics. Accuracy, sensitivity, specificity, was calculated. Mc Nemar test was used to prove significant differences between CT angiographic and DSA findings. Results: A total of 700 arterial segments were evaluated, with excellent agreement between readers (κ ≥ 0.928). On a segmental basis, both sensitivity and specificity for stenosis of 70% or more were at least 96% (386 of 400 segments and 290 of 300 segments, respectively), with an accuracy of 98% (686 of 7oo segments).There was no significant difference between CT angiographic and DSA findings (P = .62–.87). Conclusion: The diagnostic performance of 64-section CT angiography is excellent in patients with clinical symptoms of PAD.