Color duplex ultrasonography has increasing role as pre-interventional imaging as well as a guiding modality to angioplasty procedures of lower limbs’ arterial diseases in diabetic foot patients.Objective : The aim in this study is to assess the role of color duplex in diagnosis of lower limb arterial diseases and to compare color duplex with conventional fluoroscopy in guiding interventional procedures. Methods : This study included 30 patients (70% males and 30% females) aged 47 - 68 years (mean 57.13 +/- 5.48 SD). All are diabetic, 70% hypertensive, 46.7% cardiac, 30% with renal impairment, 46.7% smokers and 20% with contrast allergy. All patients were symptomatizing; 23 with claudication, 7 with rest pain, 4 with ischemic ulcers and 3 with gangrene. All of the 30 patients had preinterventional duplex; fifteen of them had fluoroscopic-guided angioplasty (group I) and the other fifteen patients had duplex-guided angioplasty (group II). The 30 patients had femoropopliteal angioplasty, six of them proceeded to infrapopliteal angioplasty to improve the distal run-off; three of them were in group I and three in group II. Statistical analyses of the results using the statistical package SPSS version 21. Data was summarized using mean and standard deviation, in quantitative data and using frequency (count) and relative frequency (percentage) for categorical data. Comparisons between quantitative variables were done using the unpaired t-test. For comparing categorical data, Chi square test was performed. Exact test was used instead when the expected frequency is less than 5. P-values less than 0.05 were considered as statistically significant. Results : The overall technical success was 93.3% (28/30 cases). Failure was found in one case for each group. Duplex guided angioplasty was the safest modality for patients with renal impairment and contrast allergy. The rate of complications was less in group II. These complications were more in fluoroscopy guided angioplasty group, such as thrombosis/embolism in one case, one case with gross hematoma and another with pseudoaneurysm. The data found at the preinterventional duplex was matching to the operative data found in the fluoroscopy guided angioplasty in 93% of cases. Conclusion : Color duplex ultrasonography is as effective as fluoroscopy in guiding the intervention procedures, with fewer rates of complications. Duplex guided angioplasty was the safest available modality for patients with renal impairment and contrast allergy. We recommend color duplex sonography as the preferable method for guiding intervention procedures.