PURPOSE: To report results of primary stent placement for treatment of chronic iliac artery occlusions. MATERIALS AND METHODS: The authors placed 154 primary stents in 103 patients with iliac artery occlusions of at least 3 months duration. Mean length of the occluded segments was 5.1 cm. All patients had symptoms, with claudication or trophic changes. Mean ankle-arm index at rest was 0.48. Follow-up included angiography, Doppler ultrasound, and clinical examination. RESULTS: Ninety-nine patients demonstrated clinical improvement, with relief or improvement of claudication. Complications that required percutaneous or surgical intervention occurred in six patients; minor complications occurred in another six. Embolization occurred in five patients. Primary patency was 87% after 1 year, 83% after 2 years, and 78% after 4 years; secondary patency was 94%, 90%, and 88% at 1 year, 2 years, and 4 years, respectively. CONCLUSION: Primary stent placement should be the treatment of choice in unilateral chronic iliac artery occlusion.