Objective To explore the accuracy of multi-slice spiral CT angiography (MSCTA) different image postprocessing techniques in the diagnosis of common lower extremity arterial occlusive diseases. Methods 76 cases of patients diagnosed with lower extremity arterial occlusive diseases were retrospectively analyzed. All patients underwent MSCTA. Volume reconstruction (VR), maximum intensity projection (MIP) and multiplanar reconstruction (MPR) were used for image postprocessing. Digital subtraction angiography (DSA) was performed in 2 weeks. Results With DSA as the golden standard, MSCTA diagnosed 71 patients with vascular stenosis (93.42%). In 71 patients in this study, there were a total of 1329 measurable blood vessels. The accuracy rates of MSCTA and MIP in diagnosis of lower extremity vascular stenosis ≥50% (95.79%, 90.61%) were significantly higher than that of MPR (85.68%) and VR (86.15%) (P<0.05). The total accuracy rates of MPR, MIP and VR in diagnosis of diabetic lower extremity artery stenosis and occlusion, artery injury after trauma and osteofascial compartment syndrome were 88.73%, 95.77% and 73.24%, respectively (P<0.05). Conclusion MSCTA combined with different image postprocessing techniques can be used as an ideal imaging method for diagnosis of lower extremity arterial occlusive diseases.