A 62-year old patient was admitted with a 24-hour history of ischemia in both legs caused by acute distal aortic occlusion and had had a total loss of sensitivity and motor function for 8 hours. Preoperative serum creatine phosphokinase level was 10,900 IU/ml. During aortofemoral reconstruction, both limbs were reperfused with a potassium-free, blood-cardioplegia-like perfusate. Fasciotomies were not necessary. After operation, maximal serum creatine phosphokinase levels remained below 10,000 IU/ml. Limb sensitivity and motor function were normal. Even for prolonged acute aortoiliac occlusion, a simplified controlled limb-reperfusion may preserve skeletal muscle and nerve function and prevent local and systemic complications caused by reperfusion damage.