Introducing the Minimally Invasive Novel Open Revascularization - The "MINOR" Approach - To Improve Outcomes in Lower and Upper Limb Arterial Bypass Surgery.

BACKGROUND

Traditional open limb bypass surgery has risks of perioperative complications and prolonged recovery due to large wounds and extensive dissections. We describe a new concept in bypass revascularization, the minimally invasive novel open revascularization (MINOR) approach - which has 3 elements: shortest possible length of vein bypass, endoscopic vein harvesting (EVH), limited incisions to minimise tissue damage.

METHODS

Analysis of prospectively collected data over 18 months on sequential, unselected patients treated by the MINOR approach. Primary outcomes were technical success, wound complications, and major adverse limb event (MALE) or death at 1 year. Secondary outcomes were graft patency at 1 year and limb salvage and amputation-free survival at 18 months.

RESULTS

A total of 73 patients (63% with diabetes) underwent 81 infra-brachial and infra-inguinal MINOR bypasses: 91% for chronic limb threatening ischemia (CLTI) and 9% for popliteal aneurysm. Bypasses were to popliteal artery in 19(23%), tibial arteries (distal) in 32(40%), and pedal or palmar arches (ultra-distal) in 30(37%). Bypass conduits included autologous great saphenous, small saphenous, cephalic, and basilic veins. Technical success was 100% with no significant wound complications, and a MALE or death at 1 year was 17.3%. The primary, assisted primary and secondary patency rates at 1 year were 60.5%, 76.5%, and 85.2%, respectively. 1-year mortality rate was 4%. Limb salvage and amputation-free survival rates at 18 months were 94% and 86.4%, respectively.

CONCLUSION

The MINOR approach is an efficient and safe bypass procedure, suitable for complex distal and ultra-distal bypasses, with low complication rates and favourable graft patency, limb salvage, and mortality rates. It offers improved outcomes for patients at risk of amputation from limb ischemia.