Acute mesenteric ischemia (AMI) is life-threatening and requires early multimodal medical and surgical interventions. Knowing the etiology of AMI plays a key role in patient management and outcomes. Once knowledge of the etiology has been made, timing for treatment of AMI is of the essence. The first medical intervention for AMI is intravascular fluid replacement in order to stabilize hemodynamics. In patients with acute peritonitis or CT evidence of preexisting gangrene of the intestine, gas in the wall of the intestine or the portal venous system requires exploratory laparotomy with possible open revascularization interventions. In patients without peritonitis, endovascular therapy can be attempted before laparotomy as the primary revascularization method and is gaining popularity as part of a multimodal approach. O. Corcos et al. in a prospective Intestinal Stroke Center analysis of 18 consecutive patients, developed a similar multimodal management strategy.