John A Kaufman

Oregon Health and Science University, Portland, Oregon, United States

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Publications (164)524.45 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Transjugular intrahepatic portosystemic shunt (TIPS) creation increases the risk of hepatic encephalopathy due to overshunting. Techniques exist to secondarily reduce the shunt for refractory encephalopathy. The purpose of this article is to describe a technique for primary TIPS restriction using a balloon-expandable stent within the transvenous hepatic track followed by deployment of a self-expanding polytetrafluoroethylene-lined stent-graft within the balloon-expandable stent to create the TIPS. This technique enables control over the degree of portosystemic shunting in elective TIPS creation.
    American Journal of Roentgenology 04/2015; 204(4):868-871. DOI:10.2214/AJR.14.13104 · 2.74 Impact Factor
  • Journal of Vascular and Interventional Radiology 02/2015; 26(2):S156-S157. DOI:10.1016/j.jvir.2014.12.421 · 2.15 Impact Factor
  • Journal of Vascular and Interventional Radiology 02/2015; 26(2):S213. DOI:10.1016/j.jvir.2014.12.568 · 2.15 Impact Factor
  • Journal of Vascular and Interventional Radiology 02/2015; 26(2):S160. DOI:10.1016/j.jvir.2014.12.431 · 2.15 Impact Factor
  • John A Kaufman
    Radiology 11/2014; 273(2):318-21. DOI:10.1148/radiol.14141263 · 6.21 Impact Factor
  • Seminars in Interventional Radiology 06/2014; 31(2):107-10. DOI:10.1055/s-0034-1373784
  • John A Kaufman
    Journal of vascular and interventional radiology: JVIR 11/2013; 24(11):1669-70. DOI:10.1016/j.jvir.2013.08.019 · 2.15 Impact Factor
  • Journal of vascular and interventional radiology: JVIR 11/2013; 24(11):1609-12. DOI:10.1016/j.jvir.2013.08.002 · 2.15 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S328-S329. DOI:10.1016/j.ijrobp.2013.06.865 · 4.18 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S326-S327. DOI:10.1016/j.ijrobp.2013.06.859 · 4.18 Impact Factor
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    ABSTRACT: Since the development of intravascular ultrasound in the late 1980s, the modality has been used both to image the vascular system and to direct interventions in target vessels. Intravascular ultrasound (IVUS) was initially used to image atherosclerosis and aid in its treatment, but it has more recently been employed within the venous system, allowing for both intravenous and transvenous image-guided interventions. IVUS is now used for both direct and transjugular intrahepatic portosystemic shunt placement, for transcaval liver biopsy and transcaval puncture of type II endoleaks, and for cardiac mass biopsy, among other interventions. The use of IVUS not only yields potential for reduced fluoroscopy dose in and increased safety of established procedures, but it also allows for the development of altogether new procedures.
    Techniques in vascular and interventional radiology 09/2013; 16(3):161-7. DOI:10.1053/j.tvir.2013.02.011
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    ABSTRACT: Hepatopulmonary shunt (HPS) fraction ≥20% is one of the occasional criteria preventing 90Y therapy. This study aimed to identify if there is clinical correlation between hepatic vein (HV) opacification and HPS during initial evaluation for 90Y therapy.Materials and Methods We collected 90Y candidates from 2004 to 2011. Patient’s underlying disease, imaging, arteriograms, and HPS calculations were retrospectively reviewed. If the HV was opacified during visceral arteriogram, the time between contrast injection and HV visualization was recorded. Statistical analysis with unpaired t-test compared the time of HV visualization in patients with and without an elevated HPS fraction.ResultsTotal of 151 initial 90Y work up studies in 149 patients were included. The diagnoses included 75 HCC, 53 neuroendocrine tumor metastases, 14 colorectal metastases, 3 cholangiocarcinoma and 4 other metastases. Imaging revealed multifocal disease(n=117, 77%), bilobar disease(102, 68%) and macrovascular invasion (41, 27%). Macrovascular invasions included 4 HV and IVC, 2 HV and portal vein (PV), 1 IVC, 11 main PV, 1 right main PV, 16 right PV branch, 2 left main PV and 4 left PV branch. Mean maximum tumor diameter was 6.9±3.6 cm. Twenty-nine patients (19%) did not complete Y90 therapy; due to (18) high HPS, (5) unfavorable vascular anatomy, (2) declining liver function, (1) gastric uptake, (1) extrahepatic tumor, (1) poor tumor localization and (1) misdiagnosis. HV opacification was noted in 15 studies. Nine out of 15 studies showed HPS fraction ≥20%. PPV and NPV of HV opacification as a predictor of high HPS fraction were 60% and 94%. Average time until visualized HV in patients whom HPS fraction ≥20% and <20% were 4.2 and 8.6 sec (p= 0.3). The difference of mean times between two group was 4.4 sec (95% CI - 0.4-8.3).Conclusion The results demonstrated that visualization of the HV during initial arteriogram alone may not be sufficient to predict high HPS. We found that HV opacifications were seen on arteriograms earlier in the patients with high HPS (≥20%) than the patients with shunt <20%. However, the time difference in HV visualization between the two groups was not statistically significant due to the small sample size.
    Journal of Vascular and Interventional Radiology 04/2013; 24(4):S164. DOI:10.1016/j.jvir.2013.01.413 · 2.15 Impact Factor
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    ABSTRACT: Three methods for placement of a primary constrained transjugular intrahepatic portosystemic shunt (TIPS) will be reviewed.BackgroundTIPS creation is often complicated by hepatic encephalopathy. Medical management fails in approximately 5-10% of cases. In those patients, TIPS revision may be required by creating a flow-limiting stent using a variety of methods. To avoid the complication of hepatic encephalopathy, however, we occasionally place primary constrained stents during the initial TIPS creation, particularly if the indication for TIPS is refractory ascites.Clinical Findings/Procedure DetailsWe take one of three approaches to creating a primary constrained TIPS. In one approach, a self-expanding 10 mm Gore-Viatorr stent graft is deployed and a 5-0 Prolene suture is tied around the midpoint. The modified graft is then crimped into a peel-away sheath and re-sterilized. After formation of the intrahepatic tract, the graft is deployed and balloon dilated. The suture creates a flow-limiting constriction which may be dilated and/or broken as needed to improve flow. Prolene is favored due to its high elasticity, which allows for balloon expansion. Another approach involves deploying the stent graft through a balloon-expandable bare metal stent. After accessing the portal vein, we place a short 6-8 mm bare metal stent within the intrahepatic tract. Once this stent is in place, the Viatorr stent graft is deployed within it and the entire assembly is dilated to the diameter needed. The outer stent maintains a constriction in the inner stent graft due to its higher radial force, and can be dilated at a later time. In the third technique, a balloon-mounted Atrium iCast stent graft is placed on a 10-French sheath and a 4-0 absorbable suture is tied around its midpoint. This stent is then crimped onto a balloon and deployed, with the suture serving as the constriction point. Dilation can be done at a future time if needed.Conclusion and/or Teaching PointsCreation of a primary constrained TIPS can be readily performed, enabling a degree of control over reduction of the portosystemic gradient both at initial TIPS creation and at follow up. Whether these techniques result in a reduction of hepatic encephalopathy requires further investigation.
    Journal of Vascular and Interventional Radiology 04/2013; 24(4):S152-S153. DOI:10.1016/j.jvir.2013.01.382 · 2.15 Impact Factor
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    ABSTRACT: To evaluate both the clinical and imaging response of unresectable hepatic neuroendocrine metastasis after treatment with Y-90 microsphere radioembolization.Materials and Methods This is a single institution retrospective review of 26 patients with neuroendocrine hepatic metastasis treated with Y-90 microsphere radioembolization. Clinical symptoms, biochemical markers and imaging at regular intervals of 1, 3, 6, 12 and 18 months post-procedure were reviewed. The patient's clinical and imaging response were evaluated. Other medical and interventional therapies were recorded. The two largest hepatic lesions were measured and tumor response was determined by RECIST 1.1 criteria.ResultsThere were equal numbers of males and females. The mean patient age was 60, with a range of 26 to 88. Primary neuroendocrine sites were the small bowel (10), pancreas (6), colon and rectum (4), other (4) and unknown (2). Six patients (23%) underwent prior open radiofrequency ablation therapy. Twenty-one patients (81%) also received transarterial chemoembolizations. Most patients (77%) had a single Y-90 treatment. All patients had been treated with octreotide. Partial response was seen in 11 patients (42%), stable disease in 13 patients (50%) and progressive disease in 2 patients (8%). Biochemical marker response was evenly split, half increasing and half decreasing after therapy. Symptomatic improvement was noted in 18 patients (69%). Both patients with progressive disease had symptomatic improvement.Conclusion It has been shown that Y-90 microsphere radioembolization is a safe and effective therapy for hepatic neuroendocrine metastasis. Our data shows that this therapy also improves clinical symptoms. While further evaluation is needed, radioembolization may be able to play a larger role in the management of clinical symptoms.
    Journal of Vascular and Interventional Radiology 04/2013; 24(4):S151. DOI:10.1016/j.jvir.2013.01.378 · 2.15 Impact Factor
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    ABSTRACT: To assess the synergistic effect (benefit), if any, of combining TIPS and BRTO for the management of gastric variceal (GV) bleeding. The hypothesis being that TIPS compensates for the closure of the gastrorenal shunt (a spontaneous portosystemic shunt) during the BRTO procedure.Materials and MethodsA retrospective audit of patients undergoing BRTO for the management of GV bleeding was performed (2007-2012) in 8 centers in the United States. The cohort was divided into patients that underwent BRTO only and those that underwent BRTO with coexisting TIPS (BRTO+TIPS group). The BRTO+TIPS group was subdivided to concomitant TIPS (TIPS created within 2 weeks from the BRTO) and prior TIPS (>2 weeks prior to the BRTO). Demographic comparisons were made between the groups. Kaplan-Meier method was used for rebleed and survival rates (comparisons were by Log-Rank test).Results100 patients underwent BRTO only and 18 patients underwent BRTO with a coexisting TIPS. The technical and GV obliterative rate for BRTO+TIPS compared to BRTO only was 100% (n=18/18) and 100% (n=18/18) compared to 91% (n=94/103) and 80% (n=80/100), respectively (p=0.039). The complication rate and 30-day mortality for BRTO+TIPS compared to BRTO only was 6% (n=1/18) and 11% (n=2/18) compared to 2% (n=2/103) and 5% (n=5/100), respectively (p=0.3 to 0.4). The long-term outcomes of successful procedures are shown in the table.Conclusion Despite the trend of reduced rebleeding and the occurrence clinically significant ascites in patients undergoing BRTO with coexisting TIPS compared with BRTO-only, TIPS adds no significant value to the BRTO procedure. Patients with prior TIPS have a better survival than patients who undergo a combined BRTO and TIPS procedure. Table 1
    Journal of Vascular and Interventional Radiology 04/2013; 24(4):S63-S64. DOI:10.1016/j.jvir.2013.01.146 · 2.15 Impact Factor
  • Ryan Priest, Mark Garzotto, John Kaufman
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    ABSTRACT: Benign prostatic hyperplasia is a common condition, causing symptoms in 75% of men over the age of 70. To understand the role of a novel treatment for this condition, an understanding of the pathology, approach to diagnosis, and range of existing therapies are important. This article provides a general overview of benign prostatic hyperplasia evaluation and management.
    Techniques in vascular and interventional radiology 12/2012; 15(4):261-4. DOI:10.1053/j.tvir.2012.10.001
  • International Journal of Radiation OncologyBiologyPhysics 11/2012; 84(3):S334. DOI:10.1016/j.ijrobp.2012.07.880 · 4.18 Impact Factor
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    ABSTRACT: PURPOSE: To describe the use of intravascular ultrasound (US) guidance for creation of transjugular intrahepatic portosystemic shunts (TIPSs) in humans. MATERIALS AND METHODS: The initial 25 cases of intravascular US-guided TIPS were retrospectively compared versus the last 75 conventional TIPS cases during the same time period at the same institution in terms of the number of needle passes required to establish portal vein (PV) access, fluoroscopy time, and needle pass-related complications. RESULTS: Intravascular US-guided TIPS creation was successful in all cases, and there was no statistically significant difference in number of needle passes, fluoroscopy time, or needle pass-related complications between TIPS techniques. Intravascular US-guided TIPS creation was successful in cases in which conventional TIPS creation had failed as a result of PV thrombosis or distorted anatomy. Intravascular US guidance for TIPS creation was additionally useful in a patient with Budd-Chiari syndrome and in a patient with intrahepatic tumors. CONCLUSIONS: Intravascular US is a safe and reproducible means of real-time image guidance for TIPS creation, equivalent in efficacy to conventional fluoroscopic guidance. Real-time sonographic guidance with intravascular US may prove advantageous for cases in which there is PV thrombus, distorted anatomy, Budd-Chiari syndrome, or hepatic tumors.
    Journal of vascular and interventional radiology: JVIR 10/2012; 23(12). DOI:10.1016/j.jvir.2012.08.023 · 2.15 Impact Factor
  • John A Kaufman
    Journal of vascular and interventional radiology: JVIR 09/2012; 23(9):1117-24. DOI:10.1016/j.jvir.2012.06.011 · 2.15 Impact Factor
  • Michael V Beheshti, Mary E Meek, John A Kaufman
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    ABSTRACT: Strategic planning and business planning are processes commonly employed by organizations that exist in competitive environments. Although it is difficult to prove a causal relationship between formal strategic/business planning and positive organizational performance, there is broad agreement that formal strategic and business plans are components of successful organizations. The various elements of strategic plans and business plans are not common in the vernacular of practicing physicians. As health care becomes more competitive, familiarity with these tools may grow in importance. Herein we provide an overview of formal strategic and business planning, and offer a roadmap for an interventional radiology-specific plan that may be useful for organizations confronting competitive and financial threats.
    Journal of vascular and interventional radiology: JVIR 07/2012; 23(9):1181-6. DOI:10.1016/j.jvir.2012.05.044 · 2.15 Impact Factor

Publication Stats

3k Citations
524.45 Total Impact Points

Institutions

  • 2001–2014
    • Oregon Health and Science University
      • • Department of Medicine
      • • Dotter Interventional Institute
      Portland, Oregon, United States
  • 2006
    • University of Portland
      Portland, Oregon, United States
  • 1994–2005
    • Massachusetts General Hospital
      • Department of Radiology
      Boston, Massachusetts, United States
  • 2000–2004
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1995–2001
    • Harvard Medical School
      • Department of Radiology
      Boston, Massachusetts, United States
  • 1999
    • Brigham and Women's Hospital
      • Department of Radiology
      Boston, MA, United States
  • 1996–1999
    • Roswell Park Cancer Institute
      Buffalo, New York, United States
  • 1998
    • Chang Gung Memorial Hospital
      T’ai-pei, Taipei, Taiwan