Chronic mesenteric ischemia (CMI) poses a significant clinical challenge due to its varying manifestations across different age groups [1]. It is characterized by gradual stenosis of the mesenteric arteries, primarily due to atherosclerosis, resulting in insufficient blood flow to the bowel. This chronic hypoperfusion leads to the class constellation of postprandial abdominal pain, fear of eating, and weight loss, ultimately impacting quality of life and nutritional status [2,3]. Although CMI is rare, it can progress to acute-on-chronic ischemia, a life-threatening emergency [3].

Older adults are particularly susceptible to CMI due to their increased risk of developing atherosclerosis. The increased vascular stiffness and endothelial dysfunction, coupled with a higher prevalence of comorbidities, such as diabetes, hypertension, and hyperlipidemia associated with aging, further complicate this condition [4,5]. The diagnosis is often delayed due to the misattribution of atypical clinical symptoms to the diverse causes of chronic abdominal pain with weight loss, as well as the effects of comorbidities and polypharmacy [1,6].

Despite advancements in diagnostic and treatment techniques, a gap remains in the evidence-based data specific to older adult patients. A literature search was conducted in PubMed and scholarly articles using the keywords “mesenteric artery occlusion” and “chronic mesenteric ischemia.” We have included the relevant English-language articles addressing management and outcomes strategies related to CMI. Articles reporting on acute mesenteric ischemia only were excluded from the study. No formal quality analysis of the articles was conducted. The eligible articles were reviewed in a narrative format to observe age-specific factors that may influence clinical decision making to establish a comprehensive understanding of the evolving practices and challenges within this population.