Therapeutic high-dose radiation can induce atherosclerotic changes of affected arteries. Radiation-associated atherosclerotic diseases of coronary, carotid and subclavian arteries have been demonstrated for years in cancer survivors, but peripheral arterial disease (PAD) associated with radiation is rarely reported. PAD is one of the major macrovascular complications of diabetes and is associated with morbidity and increased mortality. We experienced a case of PAD associated with radiation therapy in a 65-year-old diabetic female patient who had undergone cervical cancer treatment 19 years prior. Computed tomographic angiogram showed occlusion and stenosis from common iliac arteries to superficial femoral arteries. However, both infrapopliteal arteries that are commonly involved in diabetes associated PAD were preserved. She was successfully treated with percutaneous angioplasty combined with femoro-femoral bypass operation. Based on the extent and severity of arterial stenosis in this nonsmoking diabetic woman who had a history of high-dose radiation to her pelvis, we concluded that atherosclerotic lesions in this patient were caused by high-dose pelvic irradiation and then exacerbated by diabetes. Therefore, special attention should be given to diabetic patients with history of pelvic irradiation with regard to development of atherosclerosis of peripheral arteries, especially in the pelvic area.