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Purpose: To analyse the use of transcatheter embolisation., Material and Methods: We report on 43 patients treated by transcatheter embolisation for head and neck haemorrhage from 1987 to 1995. There were 13 patients with idiopathic intractable epistaxis, 6 with iatrogenic and three with traumatic bleeding, 7 patients with bleeding from vascular malformations, 12 patients with haemorrhage from tumours, one ruptured aneurysm of the inferior thyroid artery and one patient bleeding from a retrolingual dystrophic goitre., Results: In 11/13 patients with idiopathic epistaxis, this could be stopped. In 8/9 of the traumatic and iatrogenic bleedings the haemorrhage was treated by embolisation alone. In two cases additional elective surgical interventions were necessary. In 6/7 patients with vascular malformations embolisation resulted in long-lasting periods free from bleeding. Palliative embolisation in bleeding tumours resulted in haemostasis in 10/12 patients. Bleeding was definitely stopped in a patient with aneurysm of the inferior thyroidal artery as well as in a patient with bleeding from a dystrophic goitre. We observed a total of three complications, two transitory neurological disturbances and one permanent amaurosis., Conclusion: Transcatheter embolisation is an effective tool in the treatment of life-threatening head and neck bleedings.

Sixteen cases of endovascular treatment of aneurysms and pseudoaneurysms were reported; five patients had true aneurysms, 11 presented pseudoaneurysms of splanchnic arteries. In all cases embolization was performed with coils; in one case we used coils in combination with Ethibloc. In 14 of 16 patients definite occlusion of the aneurysms was achieved without further surgical intervention.

With the spread of laparoscopic cholecystectomy more and more complications are being reported. For the first time in this paper a pseudoaneurysm of the right hepatic artery as a complication of laparoscopic cholecystectomy in a 55 year old patient is described. During embolization the aneurysm ruptured and an emergency laparotomy was performed. The right hepatic artery was ligated. The postoperative course up to follow-up at 6 months was uncomplicated.

Blood-sugar levels below 40 mg/dl were measured during syncope in two female patients (aged 59 and 73 years). Suspected organic hyperinsulinism was confirmed by a fasting test. Ultrasound examination and computed tomography failed to demonstrate an insulinoma. Coeliacomesentericography was then undertaken together with a selective intra-arterial calcium provocation test of the pancreas (0.4 or 0.5 mmol calcium in physiological saline was injected into the pancreas-supplying arteries--proximal and distal splenic, superior mesenteric and gastroduodenal). The insulin level was determined in simultaneously obtained hepatic venous blood. In case 1, the insulin level rose tenfold after calcium injection into the proximal splenic artery, indicating a process in the body of the pancreas. In case 2, a steep rise in insulin occurred after injection into the truncus coeliacus and the proximal and distal splenic artery, suggesting an insulinoma in the tail of the pancreas. The site of the insulinoma was confirmed in both cases at surgery. The adenoma was enucleated in case 1, removed by partial resection of the tail of the pancreas in case 2.--These observations show that occult insulinomas can be localized preoperatively by intraarterial calcium injection with measurement of insulin concentration in simultaneously obtained hepatic venous blood.

The embolisation (microspirales) of the diverticle-bleeding of the colon is an alternative treatment to the operative colon resection. Advantages for the most older patients are fewer complications and no risk of anaesthesia. An intensive surgical care after embolisatio is necessary to prevent peritonitis in the case of a colon perforation. The risk of an elective colon resection after embolisation if necessary is less than that of resection in cases of emergency.