Owing to a heightened awareness of the disease as well as improved diagnostic tests, chronic mesenteric ischemia is now recognized as a more common cause of abdominal pain. The classic symptoms of postprandial abdominal pain with weight loss are evident in the majority of proven cases; most patients also have other evidence of advanced atherosclerotic vascular disease. Several new diagnostic techniques are being developed and tested, most notably color duplex imaging, although angiography still remains the diagnostic gold standard. It is hoped that better noninvasive testing may eventually eliminate the need for angiography, as well as lead to a more expedient diagnosis of chronic mesenteric ischemia.