Acute mesenteric ischemia is a surgical emergency commonly caused by embolic or thrombotic occlusion of the superior mesenteric artery. Prompt diagnosis, fluid resuscitation, systemic anticoagulation, and mesenteric revascularization are key tenants to the treatment of this lethal condition. Revascularization can be performed via open thromboembolectomy or surgical bypass, endovascular techniques, or a hybrid approach of the 2. Despite technological advancements, mortalities remain high, and the plan of care and revascularization should be based on the patient’s clinical status and available medical center resources.