International Cross Sectional Survey on the Management of Mesenteric Arterial Ischaemia and Renal Artery Stenosis from the European Visceral Artery Revascularisation Study Participants.

Objective: The European Visceral Artery Revascularisation (EVisAR) Study initiative (ClinicalTrials.gov NCT06913530) is an ambispective study focusing on long term outcomes of visceral arterial diseases. Despite recent advances, optimal management remains uncertain owing to limited and fragmented evidence. The present survey aimed to assess the current clinical practices of EVisAR participants. Methods: All 107 EVisAR physicians were invited in a single-round, international, cross-sectional survey. The survey covered chronic mesenteric ischaemia (CMI), acute mesenteric ischaemia (AMI), and renal artery stenosis (RAS), focusing on diagnostic pathways, indications for intervention, treatment preferences, and follow up strategies. Responses were analysed descriptively, and inter-rater agreement was assessed using the Fleiss κ method (agreement: ≥0.80 almost perfect, 0.60 - 0.79 substantial, 0.40 - 0.59 moderate, 0.20 - 0.39 fair, and <0.20 poor). Results: Sixty four (60%) EVisAR physicians' responses were obtained. Vascular surgeons (98%) from university hospitals (84%) were predominant. Less than ten cases per year were treated by 62%, 78%, and 83% of participants for CMI, AMI, and RAS, respectively. Endovascular treatment was preferred, especially in elderly, obese, and comorbid patients. For CMI, the thresholds for intervention varied widely (κ = 0.23), and endovascular stenting was preferred (95%). In AMI, revascularisation through aspiration thrombectomy followed by damage control surgery was the predominant strategy (73%). RAS was primarily managed medically (95%); revascularisation was reserved for resistant hypertension or worsening renal function, with a nearly universal preference for endovascular techniques (98%). CMI had the least concordance (κ = 0.36, 95% CI 0.28 - 0.44]); moderate agreement was found for AMI and RAS, with κ values of 0.46 (95% CI 0.35 - 0.57) and 0.41 (95% CI 0.28 - 0.54), respectively. Follow up strategies had the lowest degree of concordance for each pathology (CMI, 0.27; AMI, 0.13; and RAS, 0.19). Conclusion: This survey revealed substantial heterogeneity in the management of CMI, AMI, and RAS. Consensus is lacking, particularly regarding follow up strategies. These findings highlight the need for better quality data to refine clinical practice.