Our aim was to analyze the effect of reentry device use on iliac artery chronic total occlusion (CTO) recanalization outcomes. A retrospective review of patients with iliac artery CTO treated with subintimal angioplasty (SIA) from 2006 to 2011 was completed. We then compared the outcomes of two groups: those procedures completed with versus those procedures completed without a reentry device using SPSS software (IBM, Armonk, New York). Of the 121 iliac artery CTOs that underwent SIA, 32 cases used a reentry device while 89 did not. For the entire cohort, the mean age was 65, male 45%, hypertension 76%, hyperlipidemia 71%, diabetes 36%, and CAD 56%. Indications for the procedure included claudication (60%) and critical limb ischemia (40%). The clinical profile and indications for intervention were not statistically different for the 2 groups. Combining TASC C&D lesions, the reentry device group had a trend toward a higher percentage of more advanced lesions compared to the non reentry device group (82% versus 66% P = .07). Yet despite the more advanced lesions, the technical success rate was higher in the reentry device group (100% versus 77% P = .002). Combined major complication rate, retrograde aortic dissection, and 30-day mortality rate of the reentry group was also reduced (0% versus 10% P = .04). Lastly, the 1, 2 and 3 years primary and secondary patency rates, especially with long term follow up, appear to be improved with the use of reentry devices; primary patency at 1, 2, and 3 years for the reentry device group versus the non reentry device group (100%, 100%, 100% versus 84%, 72%, 64% P = .02), and secondary patency at 1, 2, and 3 years for the reentry device group versus the non reentry device group (100%, 100%, 100% versus 93%, 91%, 77% P = .125). The routine use of reentry devices further improves the technical success, safety, and primary patency of SIA recanalization of iliac artery CTO.