Ischemic colitis is a well-described complication of major vascular surgery, especially following open abdominal aortic aneurysm repair and endovascular aneurysm repair, but also with aortoiliac surgery, aortic dissection, and thoracic aneurysm repair. Following its onset, mortality remains high, highlighting the need for rapidly identifying the onset of symptoms and, perhaps more importantly, those patients at risk, in an attempt to prevent its onset. In this article, the authors review the causes, presentation, and diagnostic strategies of colonic ischemia. They also cover the operative management and outcomes for bowel resection and vascular repair. Finally, they evaluate some of the newer options for diagnosing this condition.