Because of the extensive collateral arterial network of the gut, chronic mesenteric ischemia is relatively uncommon. It is usually related to extensive mesenteric atherosclerosis. Patients classically present with postprandial abdominal pain, "fear of eating" and weight loss. However, most patients do not present with "classic" symptomatology and are frequently misdiagnosed for other diseases. Until patients with a high index of suspicion proceed to angiography, these patients may be treated for prolonged periods for suspected peptic ulcer, functional dyspepsia, irritable bowel syndrome, etc. Unfortunately, angiographic evidence of thrombosis of large vessels is not always diagnostic, as two or even three of the major arteries may be thrombosed in apparently asymptomatic patients. Once the diagnosis is clearly established, the treatment is surgical. Many surgical procedures have been described with various results. Endarterectomy and aortovisceral bypass have been employed. More recently balloon angioplasty has appeared to provide good results with a less invasive approach.