Dr. Jon Roberts talks about Memphis Vascular Center

Dr. Roberts interview on Channel 3 about vein treatments

Uterine Fibroid Embolization (UFE) is a minimally invasive interventional radiology treatment that shrinks the fibroids by eliminating their blood supply and effectively eliminates the need for a hysterectomy.

Women who have elected to have UFE consistently report successful outcomes and improved quality of life. “Most women who have been conclusively diagnosed with uterine fibroids are good candidates for this treatment option,” says Dr. Jon Roberts, who performed the first UFE procedure in Memphis in 1998. Dr. Roberts treats from four to six patients a week with this advanced procedure. “We evaluate all women with an MRI after the initial consultation to make certain that fibroids do exist,” assures Dr. Roberts. “We also make sure our patients understand how the procedure works and what to expect. We at the Memphis Vascular Center want every woman to have an opportunity to make an informed decision about how to eliminate the symptoms of uterine fibroids and to know that she does have a choice.”

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Uterine fibroids afflict 20 to 40 percent of women age 35 and older. Uterine fibroids are common benign growths that develop in the muscular wall of the uterus. Sizes range from a quarter of an inch to larger than a cantaloupe, and typically there is more than one fibroid present. African American women are at a higher risk of fibroids with almost 50 percent having fibroids of significant size. In the past, the standard for treating women with painful fibroids was myomectomy, an open surgery that involves cutting out the biggest fibroid or collection of fibroids then stitching the uterus back together. In extreme cases a hysterectomy is performed.

Dr. Jon Roberts analyzes ultrasound images.

Since most fibroids don’t cause symptoms, only 10 to 20 percent of women who have fibroids require treatment. For those who have pain, heavy bleeding and bladder pressure, these symptoms can be too much to ignore, and there is a minimally invasive procedure called uterine fibroid embolization (UFE). Although not a new procedure, it really has only increased in use in the past few years with greater media attention, including the fact that Secretary of State Condoleezza Rice received the procedure.

Uterine fibroid embolization is performed by an interventional radiologist while the patient is conscious. A catheter is inserted into the femoral artery while the physician uses image guidance to navigate the catheter. Tiny particles the size of grains of sand are released into the uterine arteries that supply blood to the fibroid tumor. This devascularizes the tumor, causing it to shrink. Patients typically don’t have to stay overnight; however, it can be a painful procedure, especially for patients with larger fibroids.

“I try to tell women the advantages of this are a shorter recovery time, less complications and morbidity,” explains Dr. Jon Roberts, interventional radiologist with Memphis Radiological PC. “I present it to patients as an informed option. Some women may rather go ahead and have surgery.” Side effects include pain, nausea and fever, but Roberts says they clear up in a few days. He says he usually sends patients home after four hours, not requiring them to stay overnight.

According to the Society of Interventional Radiology, an estimated 13,000 to 14,000 UFE procedures are performed annually in the United States. On average, 85 to 90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and bulk-related symptoms. The procedure has shown effective for multiple and large fibroids. Recurrence of treated fibroids is very rare. Short and mid-term data show UFE to be very effective with a very low rate of recurrence.

The embolization of fibroids was first used to decrease blood loss during myomectomy. After women underwent the devascularization procedure from a radiologist, much to the surprise of the initial users of the procedure, these patients began to feel better and opted out of the surgery. “Anybody that doesn’t have to have abdominal surgery, that’s a benefit,” says Roberts. “You can have a totally uncomplicated abdominal surgery and five years from now you start to develop adhesions. It’s very rare for us [using this procedure] to have complications of any kind.”

Interventional radiologists have a working relationship with gynecologists who refer their patients to be evaluated for the procedure. Most women with symptomatic fibroids are candidates for UFE and can obtain a consult with an interventional radiologist.

Memphis Medical News, June 2006

While a common condition, most fibroids do not produce symptoms. Only ten to twenty percent of women with fibroids require treatment. Initial treatment options include birth control pills, hormone therapy, and anti-inflammatory medications. If symptoms persist or worsen, surgical treatments available include myomectomy or hysterectomy. Nonsurgical options include endometrial ablation and uterine fibroid embolization (UFE).

UFE is a minimally invasive, outpatient procedure performed by an interventional radiologist. A catheter is introduced into the femoral artery through a small groin incision and guided into the uterine arteries that provide blood flow to the fibroids. Through that catheter, the radiologist releases small particles into the uterine arteries stopping the blood flow to the fibroids. Without blood, the fibroids eventually shrink and die alleviating the symptoms, if the symptoms are caused by fibroids.

The procedure is performed on an outpatient basis, with the patient arriving in the early AM on procedure day and being discharged the same afternoon. Pelvic pain post procedure is managed with medications during the hospital stay and at home. Light activities can be resumed in a few days and normal activities within ten days. Women experience a gradual relief of symptoms relatively quickly with continued improvement over time.

Most women with symptomatic fibroids are candidates for UFE. While some physicians deem the procedure “new”, it has been performed in the United States since 1996 and here locally since 1998. Uterine fibroid embolization offers women a widely accepted treatment choice that is minimally invasive, reducing risks, and providing a much shorter recovery time than traditional surgical options. Symptoms include:

• Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes clots. This often leads to anemia
• Pelvic pain
• Pelvic pressure or heaviness caused by the bulk or weight of the fibroids pressing on nearby structures
• Pain in the back or legs as the fibroids press on nerves that supply the pelvis and legs
• Pain during sexual intercourse
• Bladder pressure leading to a constant urge to urinate
• Pressure on the bowel, leading to constipation and bloating
• Abnormally enlarged abdomen

Dr. Jon Roberts, Interventional Radiologist, completed his medical school training at East Tennessee State University in 1990. After a five year residency in radiology at Methodist Hospitals of Memphis , he completed a year long fellowship in Interventional Radiology. He has been in practice in Memphis since 1996. He performed the first UFE in Memphis in April of 1998. Since that time he has helped over 700 women with
symptomatic fibroids.