Endovascular-first approaches are reshaping treatment for chronic mesenteric ischemia (CMI), crucial for improving patient outcomes.

• Higher prevalence noted, especially in elderly females with increased single-vessel disease recognition.
• Endovascular therapy preferred for most lesions, with covered stents showing improved patency.

Early identification and individualized revascularization strategies are vital for long-term success in CMI cases.

• Open surgery remains essential for complex cases and failed endovascular interventions.