Chronic mesenteric ischemia (CMI) is an important differential diagnosis of unclear abdominal pain. Although pathologic processes in the visceral arteries can be found regularly in older patients, symptomatic CMI becomes manifest only in a minority of the cases. Other diseases have to be excluded before the diagnosis can be made. Symptoms occur only if 2 or 3 vessels are affected (exception: Dunbar syndrome/compression of the celiac trunc). Abdominal pain that starts just after finishing a meal and that takes 30-120 minutes is the typical symptom. Weight loss is frequent, but not obligatory. The visceral arteries can be examined using ultrasound, the computed tomography angiography is the gold standard in diagnosing CMI. An indication for revascularisation is given if symptoms are present. Many endovascular and open procedures exist. Although open operations present better long-time results, the endovascular approach is preferred due to less morbidity and mortality. Main target vessel is the superior mesenteric artery. This paper describes the basics of diagnosing CMI and presents different interventional and open reconstructive techniques.