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Objective: To determine the safety and the long-term results of primary stent placement for localized distal aortic occlusive disease. Design: Retrospective observational study. Patients and Methods: From July 1998 to July 2005 17 patients (14 female and 3 men, mean age 57 years (39–80)) were treated for intermittent claudication. Five of these patients underwent additional endovascular treatment of focal iliac lesions. Results: Technical success defined as residual stenosis of less than 50% or a trans-stenotic systolic pressure gradient <10% was achieved in 14 of 17 (82%) patients. Major complications included dissection at the puncture site in one patient and thrombosis of additional iliac stents in another patient. Both of these complications were successfully treated. During a mean follow-up of 27 months (range 1–86), four patients had recurrence of symptoms due to in-stent restenoses (n=2), femoral (n=1) or iliac occlusion (n=1), respectively. By Kaplan-Meier analysis, primary aortic hemodynamic patency was 83% at 3 years. Secondary aortic hemodynamic patency was 100%. The primary clinical patency was 68% at 3 years. Conclusion: Primary stent placement for distal aortic stenoses is an alternative to surgical treatment because of its high patency and relatively low complication rates. [Copyright &y& Elsevier]