Aortoiliac occlusive disease (AIOD) represents a common manifestation of peripheral arterial disease and is frequently managed using endovascular techniques. Despite the widespread adoption of iliac artery stenting, the optimal access strategy for crossing and treating common iliac artery (CIA) lesions remains debatable. This study aimed to compare the efficacy and safety of different endovascular access approaches for CIA stenting. This prospective comparative study included 40 symptomatic patients diagnosed with AIOD who underwent endovascular stenting of the CIA. Patients were allocated into four groups according to the access strategy used: antegrade transbrachial, antegrade contralateral femoral, ipsilateral retrograde femoral, and combined antegrade–retrograde approaches. Technical success, procedural time, complications, and short-term outcomes were evaluated. Technical success was achieved in all patients treated via antegrade transbrachial, contralateral femoral, and ipsilateral retrograde femoral approaches, while one failure occurred in the combined approach group and was managed by aortobifemoral bypass. Procedural time was shortest with the ipsilateral retrograde approach and longest with the combined approach (p < 0.001). Access-site hematoma was more frequent following transbrachial access, whereas arterial dissection was significantly higher in the combined approach group. Limb salvage was achieved in all patients. All approaches for CIA stenting proved to be safe and effective, though their performance differed. Choosing the access should be based on lesion anatomy and procedural needs.

All authors contributed equally to the preparation of the manuscript. All authors read and approved the final manuscript.

Received: 01 February 2026

Accepted: 30 March 2026

Article published online:
15 April 2026

© 2026. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA