Background Data about reperfusion injury (RI) following acute arterial mesenteric ischemia (AAMI) in humans are scarce. We aimed to assess the prevalence and risk factors of RI following endovascular revascularization of AMI and evaluate its impact on patient outcomes. Methods Patients with AAMI who underwent endovascular revascularization (2016–2021) were included in this retrospective cohort. CT performed < 7 days after treatment was reviewed to identify features of RI (bowel wall hypoattenuation, mucosal hyperenhancement). Clinical, laboratory, imaging, and treatments were compared between RI and non-RI patients to identify factors associated with RI. Resection rate and survival were also compared. Results Fifty patients (23 men, median 72-yrs IQR 60–77) were included, and 22 were diagnosed with RI (44%) after a median 28 h (22–48). Bowel wall hypoattenuation and mucosal hyperenhancement were found in 95% and 91% of patients with post-interventional RI, respectively. Patients with RI had a greater increase of CRP levels after endovascular treatment ( p  = 0.01). On multivariate analysis, a decreased bowel wall enhancement on baseline CT (HR = 8.2), an embolic cause (HR = 7.4), complete SMA occlusion (HR = 7.0), and higher serum lactate levels (HR = 1.4) were associated with RI. The three-month survival rate was 78%, with no difference between subgroups ( p  = 0.99). However, the resection rate was higher in patients with RI (32% versus 7%; p  = 0.03). Conclusion RI is frequent after endovascular revascularization of AAMI, especially in patients who present with decreased bowel wall enhancement on pre-treatment CT, an embolic cause, and a complete occlusion of the SMA. However, its occurrence does not seem to negatively impact short-term survival. Key points Reperfusion injury of the bowel occurred in 44% of patients with acute mesenteric ischemia treated by endovascular revascularization. A decreased bowel enhancement on initial CT (HR = 8.2), an occlusion of the superior mesenteric artery (HR = 7.0), an embolic cause (HR = 7.4), and higher initial serum lactate level (HR = 1.4) were identified as predictors of reperfusion injury. Bowel wall hypoattenuation, hyperenhancement of the mucosa, and increase in CRP levels after revascularization were key diagnostic features of reperfusion injury.