Background: Subintimal angioplasty (SA) is being increasingly accepted as a revascularization technique for chronic arterial occlusive disease. However, its efficacy in iliac artery occlusions has not been established. Thus, we investigated the procedural and clinical outcomes of subintimal angioplasty in long iliac artery occlusions and compared them with those of intraluminal angioplasty (IA) in non-occlusive stenotic iliac artery lesions. Methods: We retrospectively analyzed data of 151 consecutive patients with long (>5 cm) iliac artery lesions (204 limbs) who underwent angioplasty with primary stent implantation from October 2004 through July 2008. Among them, 100 lesions of 100 patients were treated with intentional SA and 104 lesions of 82 patients were treated with IA. We compared the baseline characteristics and immediate and long-term outcomes of iliac artery lesions treated with SA versus IA. Results: Baseline characteristics of both groups showed that longer lesions and more severe ischemia were found in the SA group, whereas diabetes and combined femoropopliteal lesions were observed more frequently in the IA group. Technical success rate of SA was lower than that of IA (93.0% vs. 99.0%, p=0.048). However, there was no significant difference in the procedure-related complications between the SA and IA groups. (4.0% vs. 4.8%, p=0.779). Primary patency rates for SA and IA were 96.8% and 98.0% at 1 year, and 93.9% and 90.6% at 2 years, respectively (Log rank, p=0.656). Conclusion: Stent-supported SA in occlusive iliac lesions was safe and showed a high long-term patency rate comparable to that of IA performed in non-occlusive iliac lesions despite longer lesion length. Thus, SA with implantation of stent is an effective technique for the treatment of chronic long iliac artery occlusion.