Many doctors, especially those paid by Medicare, commonly perform unnecessary leg stent surgery to treat artery blockage, which could instead be addressed by lifestyle interventions, according to the findings of a new study.
In some cases, doctors implanted leg stents on 100% of patients who received consultations for the surgery. This compares to a national average of 3.5%, pointing to a larger problem of surgical overuse.
The findings were first presented at the 2019 Vascular Annual Meeting of the Society for Vascular Surgery in Washington, D.C. June 12 to 15, 2019, and published recently in the Journal of Vascular Surgery.
In recent years, there have been increasing concerns about unnecessary heart procedures, where cardiac stents were commonly placed in patients without a true medical need, exposing individuals to a risk of unnecessary side effects. In many cases, the overuse of the devices were linked to aggressive marketing tactics by manufacturers, and systems that provided incentives for surgeons and hospitals to overuse the stents.
This new research suggests that overuse of leg stents may also be a problem, particularly involving elderly individuals.
Johns Hopkins researchers used data from the Centers for Medicare and Medicaid Services, including medical claims for patients diagnosed with blocked arteries for the first time, between 2015 and 2017. Nearly 200,000 patients who had a first-time diagnosis were included, with more than 5,600 doctors conducting surgery.
Overall, three percent of patients underwent early leg stent surgery to unclog the artery. However, many doctors had procedure rates of 14% or higher when the average national rate is 3.5%
Researchers warn that some doctors are performing leg stent surgeries at alarming rates, which put patients at risk of complications or worsening disease.
The average rate of leg stent surgery as a first option was 55%, but there were 114 doctors with a 100% rate for stenting procedures. This means every person who came into their office for a consultation for a leg stent procedure ultimately had the procedure. Furthermore, 189 doctors had rates above 90%.
Leg stent surgery is often avoidable. Blocked arteries can be treated with lifestyle interventions, such as exercise and dietary restrictions. Yet, in many cases lifestyle changes were not recommended to patients. Instead they were told they needed leg stent surgery.
Patients with early leg pain, often a symptom of blocked arteries, have a 1% to 2% risk of losing a limb after five years. However, aggressive procedures like leg stent surgery can increase that risk to 5% to 10%. Leg stent surgery can cause blockage in the narrow arteries and cause the artery to rupture.
Other Reasons For Leg Pain
Some doctors indicate they will only screen for the surgery if a person has symptoms, but the main symptom calling for screening is leg pain. Many people experience leg pain and don’t have blocked arteries. In fact, most leg pain isn’t related to vascular disease.
Furthermore, most 80-year-olds have plaque in their leg artery, but it has no clinical significance and does not require surgical intervention. Yet, many doctors will call for a stent surgery anyway.
The Society for Vascular Surgery guidelines recommend surgical interventions only after lifestyle interventions have failed, and then only to patients with leg pain when they walk and who also suffer from lifestyle limiting symptoms. That means most patients who have the surgery should not get it, according to these guidelines.
Similar allegations have been raised in the past against doctors performing unnecessary coronary stent procedures. In 2015, a lawsuit was filed against a Florida doctor who was performing unnecessary heart procedures and was reimbursed through Medicare.
A study in 2018 concluded the majority of heart stent procedures failed to alleviate the symptoms of angina, or severe chest pain related to inadequate blood supply to the heart. These surgeries were not only unnecessary, but ineffective.
Researchers warn that leg stent surgery should be used selectively. Much like the unnecessary heart procedures, there is no conclusive data to show its effectiveness, especially as a first line treatment.