The AA report some considerations on the treatment and surgical approach during acute mesenteric ischemia (IMA) focusing some indications for a timely and suitable therapeutic approach. In the last 2 years, they treated 12 cases of IMA in critical patients. Early identification allows avoiding advanced phases of the intestinal infarct / bowel necrosis; in this phase the multidisciplinary approach for the hemodynamic stabilization is a priority, together with rianimatory support and surgery operation. The preservation of the intestinal vitality is essential to avoid the need of bowel resections or at least a major one . A suitable treatment permits a better survival and improvement of the quality of life. Surgical timing requires the intervention within 12 hours since the beginning of the symptoms to be more efficacious.