Leg Stent Surgery Unnecessary in Many Cases, Report Warns

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.

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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.

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11 Comments

  • RobertJanuary 6, 2023 at 10:22 am

    I am 83 at 81 had two surgeries 2 stints in my right and left leg. The doctor never told me they usually always fail or the possible side effects. He butchered me on the second surgery and now have a huge hydrocele and swelling that never has gone away. Says has nothing to do with it. Anyway, the stints failed within a year. My wife did extensive studies on non surgical inteventions and fo[Show More]I am 83 at 81 had two surgeries 2 stints in my right and left leg. The doctor never told me they usually always fail or the possible side effects. He butchered me on the second surgery and now have a huge hydrocele and swelling that never has gone away. Says has nothing to do with it. Anyway, the stints failed within a year. My wife did extensive studies on non surgical inteventions and found a medicine that is decades old, no doctor we talked to had heard of that sounded promising in getting back the blood flow to my legs. There are only a few out there and all had bad reviews and dangerous side affects (bleeding number one). So with her doing the footwork we decided to try Trental Generic Name: Pentoxifylline. It said could take up to 8 weeks and it did. It has been a year, and my legs are like they were when I was 40. Warm, no longer purple feet, and after the stints broke I could not walk to the mailbox without horrid pain. I now work outside mowing the lawn and doing yard work all day. It is like a miracle, we thought after the failed stints and how fast the pain came on 10 times worse than before surgery I was going to lose my legs. The only side affect is you need to eat with taking your med. Can cause some stomach upset, but I will take that anytime other than what was in store for me. I hope that this helps someone, as it did me. Don't give up on it, it takes awhile to kick in, but your worth it.

  • JoeyOctober 26, 2022 at 3:12 pm

    On March 2nd, 2018 I had couldn’t catch my breath, I pulled over ( I was driving from NY to PA) I called 911 and woke up 6 days later in at Erie hospital and I could barely walk. My legs got weaker and weaker. I got stents in both legs with no results, after being told I would feel 100% better. I got more stents a year later, still with no results and now my legs are weaker than ever and I h[Show More]On March 2nd, 2018 I had couldn’t catch my breath, I pulled over ( I was driving from NY to PA) I called 911 and woke up 6 days later in at Erie hospital and I could barely walk. My legs got weaker and weaker. I got stents in both legs with no results, after being told I would feel 100% better. I got more stents a year later, still with no results and now my legs are weaker than ever and I have to use a walker. Thank you for letting me vent.

  • JoseMarch 23, 2022 at 10:24 pm

    My mother is a diabetic and had got an injury on the pinky toe it never healed. Went in to doctors they amputated the toe. After the surgery the wound wasn't healing, they say it's because of the disease but I clearly saw the surgeon didn't leave enough skin to seal the wound. They recommend go see the vascular doctors. Of course they say she needs stents, the arteries clogged. Mother agrees to th[Show More]My mother is a diabetic and had got an injury on the pinky toe it never healed. Went in to doctors they amputated the toe. After the surgery the wound wasn't healing, they say it's because of the disease but I clearly saw the surgeon didn't leave enough skin to seal the wound. They recommend go see the vascular doctors. Of course they say she needs stents, the arteries clogged. Mother agrees to the surgery and got the procedure done within a few days. Mother seemed fine, I tried getting her to be more active and the stents began causing her issues no more than 6 months had passed. Now we're at a year later she can barely walk, she's in excruciating pain and her feet are limp. Mother returned to the hospital Feb 25 2022 now the doctors removed the previous stents and placed new ones. I've been in contact with her for an entire month and now she's in worse condition than before. No feeling in legs, numbness and now crippled. Feet and legs are swollen and they are sending her home. I'm so sad and frustrated, I don't know what to do.

  • RobertJanuary 26, 2022 at 5:38 pm

    I have had 5 Peripheral Artery surgeries since 5/2019. Stents in both legs, right leg bypass surgery, angioplasty and another stent placed in my right leg on 12/15/2021. Now my Vascular Surgeon says my new stent has 100% failed and he wants to do more corrective surgeries. I do not believe him anymore.

  • JudySeptember 18, 2021 at 6:21 pm

    Had 3 stents down my upper thigh 6 months ago. I was never offered any alternatives. Leg now more clogged and more painful than original condition, and foot numb, which never preceded surgery. Much worse & anxiety about future, condition worsening without alternative.

  • My name is LucySeptember 10, 2021 at 1:23 am

    Had leg stent surgery on 3/1/21 and immediately had problems. The problems went on and I was evaluated by many doctors. Only when a PhD nurse had said maybe you have an allergy to the stent. The stent is made of 55.8%nickel and 43.9% Titanium. Problems began as soon as the surgery was over. After many trips to many doctors with no relief, I was referred to a dermatologist for a patch test that sho[Show More]Had leg stent surgery on 3/1/21 and immediately had problems. The problems went on and I was evaluated by many doctors. Only when a PhD nurse had said maybe you have an allergy to the stent. The stent is made of 55.8%nickel and 43.9% Titanium. Problems began as soon as the surgery was over. After many trips to many doctors with no relief, I was referred to a dermatologist for a patch test that showed that I am allergic to nickel. I have 3 stents in my heart that are made of Cobalt and Chromium. I have had no problems with those stents at all. Have had them in since 2017 and 2018. The surgeon told me to my face that he thought that I was crazy and then he got a call from the dermatologist proving that after all the research that I had done, that I was right. He referred me to Ohio State University and I was then told that the doctor there had put in his report "the exision of the stent would be a morbid procedure and not recommended." The vascular surgeon assured me that the doctor at OSU would do the surgery and then I would be fine and able to walk again. I have not been able to walk around my apartment to take the trash out without being in severe pain. This is not a good quality of life. I need help with all of this. I am absolutely miserable.

  • LEIGHJuly 4, 2021 at 8:15 pm

    2/3 years ago i had 15 stents throughout my body for clogged arteries... had difficulty walking for a year. . No consultation was given nor follow-up. the past 2 days have been very painful in both legs ... pins and needle sensation in both of them that won't go away.. i can see the arteries in my feet and calves ... ugly. Have a Dr. appt. in 6 days to have questions answered (if possible).

  • WilbertOctober 25, 2020 at 2:04 pm

    Had two stentsssme leg

  • MichaelJune 17, 2020 at 5:43 pm

    I have had by pass surgery on my legs. On December 24 at Columbia Presbyterian Hospital they implanted 8 stents in my left leg but in all actualitit’s all I needed done was to have my graft replaced I have gortex plastic artery. Those stents cost a lot of money so they put them in and now any blood I had palpable

  • JeffreyFebruary 7, 2020 at 7:31 am

    Leg stent surgery June 2019, never any pain but my walking was poor, my legs fatigued easily. My regular doctor suggested a complete test of my circulation. He is a Mt. Sinai New York doctor so he sent me to a Mt. Sinai vascular surgeon Tadros for testing. They wrapped my legs and tested my circulation, then Tadros came in to tell me that surgical procedure was necessary and I agreed. I was ver[Show More]Leg stent surgery June 2019, never any pain but my walking was poor, my legs fatigued easily. My regular doctor suggested a complete test of my circulation. He is a Mt. Sinai New York doctor so he sent me to a Mt. Sinai vascular surgeon Tadros for testing. They wrapped my legs and tested my circulation, then Tadros came in to tell me that surgical procedure was necessary and I agreed. I was very disturbed about my walking, never any pain (I was asked) and I said okay and they immediately set up dates for procedures in both legs. I was emotionally vulnerable at the time because of my walking problem...so June 4, left leg surgery with two stents, June 14 right leg surgery, no stent, just ballooning because right leg was not as bad as left leg I was told. I was offered no alternatives and I wrote my regular doctor Rosenbluth a few hours after I had agreed to surgery, that I was nervous and would he suggest anything less invasive; He never replied! After each procedure nobody came to see me to explain what had happened, no post-surgical information. The right leg, the leg with less circulation problems, did not go well, the wound in my groin did not close, pressure was exerted on it for an hour after surgery, then a so-called pressure bandage, then 4 hours later another pressure bandage. The next morning the doctor's team arrived to pull off the bandage and send me home, but a required doppler examination evidenced that the wound had never closed. They filled the hole with something and sent me home, it was Friday and I was to return on Monday, which I did and it was closed. When I left the hospital that Friday I was weak, barely got into some clothes and they had to wheel me to a taxi and the men in my building helped me into my apartment. For the first time I took a look at my body, a mass of blood (subcutaneous), maroon color and my body was badly swollen, difficulty urinating and defecating. There's much more and it gets worse when I learned more, should never have had the procedures in the first place, wrote the Mt, Sinai Chief of Surgery about no post-surgical instructions and was rudely handled. Medicare paid Mt. Sinai $45,000.00 for the two procedures, not doubt Tadros got his share. There is much more, my walking difficulty remains.

  • PatriciaNovember 16, 2019 at 1:23 am

    I've had both legs Stented. Was told that was my only option. Now I've been told, I've got to have both legs resented in Jan 2020. Right thigh is extremely painful, have been told there is nothing that can be done about it Seems as though there is no recourse Can't find any attorney interested in helping me.

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