Acute mesenteric ischemia is a life-threatening surgical emergency associated with high morbidity and mortality rates. Presentation, physical exam, laboratory values and non-invasive imaging may all be non-specific. Angiography remains the gold standard for diagnosis. Advanced age and delay in diagnosis are associated with increased morbidity and mortality rates. Treatment includes resuscitation, mesenteric revascularization and resection of necrotic bowel. Multiple options exist for revascularization and include both open and endovascular approaches.