Mesenteric ischemia represents a spectrum of vascular disorders with high morbidity and mortality if not promptly diagnosed and treated. While advances in endovascular and surgical techniques have expanded therapeutic options, successful management still relies on a tailored, multidisciplinary approach. The most important determinant of patient outcomes remains the timeliness of diagnosis and intervention. Delayed recognition of mesenteric ischemia can result in bowel infarction, sepsis, and death, with mortality rates for acute presentations reaching 60–80%. This chapter reviews the fundamental principles of mesenteric ischemia, including vascular anatomy, pathophysiology, clinical presentation, diagnostic evaluation, and contemporary treatment strategies.