International Cross Sectional Survey on the Management of Visceral Artery Aneurysms and Isolated Dissections from the European Visceral Artery Revascularisation (EVisAR) Study Participants.

Introduction: Visceral artery aneurysms (VAAs) and isolated mesenteric and renal artery dissections (IMAD and IRAD) are uncommon conditions with unclear natural histories and uncertainties due to the lack of level 1 evidence guiding optimal management. This study was part of the European Visceral Artery Revascularisation (EVisAR; ClinicalTrial.gov NCT06913530) study initiative. A single round, international, cross sectional online survey, in compliance with the Checklist for Reporting of Survey Studies (CROSS), was conducted to assess current heterogeneity for the management of VAAs, IMAD, and IRAD across Europe. Method: EVisAR physicians were invited and surveyed with questions on caseload, diagnostic pathways, treatment indications and strategies, and follow up protocols. Responses were analysed descriptively, and inter-physician agreement was estimated with the Fleiss κ method. Results: A total of 54 physicians completed the survey (of 107 invited); 98% were vascular surgeons from 12 European countries and one from Australia. Institutional caseloads were low (fewer than ten cases/year) for both conditions. Aneurysm size thresholds for intervention varied depending on the location, with 2 - 3 cm being common for several arteries and an agreement for a 3 cm threshold for renal and splenic artery aneurysms (74% and 65%, respectively). Endovascular intervention was the preferred approach for VAAs and dissections (98%). Initial IMAD management largely depended on clinical status and most frequently included triple medication (antihypertensive, anticoagulant, and antiplatelet, 68%), fasting (63%), monitoring of biomarkers for intestinal ischaemia (89%), and a second scan at one to three days (63%). Overall agreement on management was moderate for VAA (κ = 0 .41) and IMAD and IRAD (κ = 0.40). For both, the lowest agreement was observed for follow up indications (κ = 0.03 and κ = 0.32, respectively). Conclusions: Current management shows substantial heterogeneity and a lack of consensus, particularly concerning long term surveillance and specific therapeutic approaches, although endovascular interventions seem to be the preferred strategy. These findings underscore the urgent need for high quality data and support the ongoing need for the EVisAR study.