Arterial embolism is the most frequent cause of mesenteric ischemia. The superior mesenteric artery is particularly affected. Cardiovascular comorbidities as well as age are predisposing risk factors. A three-phase clinical course is typical. After initiation of the diagnostics with computed tomography angiography (CTA), basic measures (anticoagulation, volume therapy, antibiotics) should be performed until the fastest possible revascularization. Surgical thrombectomy is considered the most established therapeutic procedure, and in the case of failure bypass grafting or local thromboendarterectomy can be performed. In selected patients endovascular treatment can also be performed, although only limited data are available for this. After revascularization, the principle of damage control surgery applies, whereby a sparingly applied resection of infarcted bowel segments is performed and, if necessary, a second look operation is initiated to assess bowel viability.