International Cross-Sectional Survey ON TReatment Of Occluded Femoro-Popliteal Stents (SUNROOF)
Authors: Bertagna Giulia , Troisi Nicola , Lepidi Sandro , Patrone Lorenzo , Yeung Kak Khee , Berchiolli Raffaella , D’Oria Mario , Angiletta Domenico , Antonello Michele , Asciutto Giuseppe , Bafile Gennaro , Bahaa Nasr , Bellosta Raffaello , Benedetto Filippo , Bertoglio Luca , Bissacco Daniele , Bosiers Michel , Bracale Umberto Marcello , Migliara Bruno , Coscas Raphaël , Pereira Tiago Costa , Cvjetko Ivan , D’Oria Mario , de Donato Gianmarco , Deloose Koen , Digvijay Sharma , Dorigo Walter , Dua Anahita , Hussein Emad , Freyrie Antonio , Garelli Guillermo , Gargiulo Mauro , Shantonu Kumar Ghosh , Isernia Giacomo , Mufty Hozan , Ippoliti Arnaldo , Kahlberg Andrea , Korosoglou Grigorios , Kwok Ricky , Langhoff Ralf , Liapis Christos , Lichtenberg Michael , Maene Lieven , Mansour Wassim , Manzi Marco , Martelli Massimiliano , Moreira Ricardo , Nikolov Nadelin , Oddi Fabio Massimo , Palena Luis Mariano , Patelis Nikolaos , Cebrián Javier Peinado , Piffaretti Gabriele , Pratesi Giovanni , Pulli Raffaele , Robinson Scott , Giudice Rocco , Neves João Rocha , Ruffino Maria Antonella , Melo Ryan , Saab Fadi , Siani Andrea , Sirignano Pasqualino , Spiliopoulos Stavros , Stavroulakis Konstantinos , Tinelli Giovanni , Torsello Giovanni , Trimarchi Santi , Ucci Alessandro , van den Berg Jos C , van den Heuvel Daniel , Van Herzeele Isabelle , Venermo Maarit , Veraldi Gian Franco , Veroux Pierfrancesco , Verzini Fabio , Ysa August , Zayed Hany , Zlatanovic Petar 
Published: September 2024

Purpose: The aim of this project is to explore practice patterns of experienced vascular specialists involved in the treatment of patients with arterial femoro-popliteal in-stent occlusion (ISO) and to understand key concepts and shared thoughts, throughout an international cross-sectional survey. Materials and Methods: The web-based survey was in English and included 31 questions. One-hundred experts were invited by email to fill in the survey anonymously on Google Forms using a dedicated link. Reminders were sent after the first 2 weeks. In addition to reporting of pooled responses, subanalyses of answers were also performed, according to country of origin (European vs non-European), years of experience (≤20 years vs >20 years), and type of institution (Academic/University vs Non-academic/Private). Results: A total of 77 physicians from 22 countries completed the survey. Most responders were males (70/77, 91%). Most of the participants were vascular surgeons (58/77, 75%). Endovascular therapy was the preferred option in patients presenting with either acute limb ischemia, disabling intermittent claudication, or chronic limb-threatening ischemia. Atherectomy/thrombectomy+Drug-Coated Balloon (DCB) was the preferred endovascular modality (32/77, 42%). No differences between country of origin, years of experience, and type of institution of the participants were found. Conclusions: The international SUrvey oN TReatment Of Occluded Femoro-Popliteal Stent (SUNROOF) survey has suggested that endovascular therapy is the preferred method for the treatment of femoro-popliteal ISO. This survey could represent a good starting point for future research on comparison between open and endovascular approach and different devices, which currently lacks good-level scientific evidence and appropriate guidelines. Clinical Impact The international SUNROOF survey included 31 questions. It was performed by 77 vascular physicians from 22 countries. More than a half of respondents considered an endovascular approach as the preferred treatment modality in acute limb ischemia, disabling intermittent claudication, or chronic limb-threatening ischemia. Most responders agreed they would intensify the follow-up protocol and anti-thrombotic medications regimen after a first in-stent occlusion episode. This survey could represent a good starting point for future research on comparison between open and endovascular approach and different devices, which currently lacks of good level scientific evidence and appropriate guidelines.