Although chronic mesenteric ischemia is an infrequent, even rare, condition and a busy vascular surgeon may encounter only one such patient in a year, the associated morbidity and mortality are high, especially if the condition is not recognized. General and vascular surgeons must bear in mind the triad of postprandial pain, weight loss and diarrhea. Patients with mesenteric ischemia are at high risk and generally have diffuse peripheral vascular disease. Although surgery is hazardous, successful repair can result in long-term survival without morbidity. The author favours antegrade supraceliac bypass grafting over infrarenal grafting which is technically more difficult.