Acute arterial occlusion of the lower extremity is a time-dependent emergency that requires prompt revascularization. Lower extremity extracorporeal distal revascularization (LEEDR) is a technique that can be initiated bedside when definitive therapy is delayed. The aim of this study is to evaluate this technique in a swine model of prolonged extremity ischemia. Anesthetized swine underwent right femoral and left posterior tibial artery cannulation, left iliac venous flow monitoring (mL/min), and continuous left anterior compartment pressure (CP) monitoring (mm Hg). The iliac artery was clamped for 6hr. LEEDR animals underwent 5hr of extracorporeal femoral-to-tibial blood flow at 150mL/min; controls had no intervention. At 6hr, LEEDR was discontinued, iliac flow restored, and anterior CP monitored for 3hr. Baseline characteristics were similar across both the groups. Iliac clamping saw an expected fall in iliac venous flow (258±30 to 82±19; P<0.001). LEEDR resulted in a rise in iliac venous flow (82±20 to 181±16; P<0.001); control arm flow remained reduced (71±8; P<0.001). Once inflow was restored, venous flow returned to baseline. Revascularization provoked a higher peak CP in the control arm versus in the LEEDR group (25±5 vs. 6±1; P=0.02). An extracorporeal circuit can temporarily revascularize an extremity in a swine model of prolonged ischemia, mitigating reperfusion injury and maintaining normal CPs. This concept should undergo further evaluation as a bedside tool to mitigate extremity ischemia prior to definitive revascularization.