Mesenteric vascular problems are infrequent, but may be catastrophic. Chronic mesenteric ischemia (CMI) is a morbid disease that results from progressive stenotic disease of the mesenteric vessels. CMI presents with postprandial abdominal pain, inanition, fear of food And weight loss. Untreated,The mortality in acute intestinal ischemia is high (50%-70%). Vascular reconstruction is remarkably successful in relieving the symptoms of chronic intestinal ischemia . The goal of treatment for CMI is a safe and effective revascularization that provides the patient with immediate and durable relief of symptoms, minimal procedural risk, and protection from morbidity and mortality associated with intestinal ischemia. Optimal treatment for patients with CMI remains controversial and challenging. Open surgical revascularization is still considered the standard of care, but may be associated with significant morbidity and mortality. We presented a patient with severe abdominal pain after meals, repeatedly. Angiography revealed severe stenosis and occlusion of the super mesenteric artery (SMA). Endovascular treatment was initially unsuccessful, after that we did a open bypass with full clinical and nutritional recovery.