PURPOSE: We have examined the effectiveness of the limb washout method by which we have managed acute lower extremity arterial occlusion complicated by myonephropathic metabolic syndrome (MNMS).METHODS: Twelve patients with bilateral iliac artery occlusions (saddle embolism) were treated. We divided them into three groups. Two had thrombectomy within 8 hours of the onset of acute arterial occlusion and had limb washout using roller pump and Cellsaver ( R) before reperfusion of the ischemic limbs (group A); two had thrombectomy only within 8 hours of the onset (group B); eight had thrombectomy only after 8 hours of the onset (group C).There were two deaths in group B and five in C, and one amputation in group B and five amputations in C. All limbs were salvaged in group A.CONCLUSIONS: The limb washout was effective for the prevention of the deterioration of MNMS and limb salvage.