Transhepatic portal venous embolization does not reduce immediate or long-term mortality or the incidence of rebleeding in patients with acute hemorrhage from gastroesophageal varices. Since in addition the procedure is not without risk to the operator, who is exposed to a considerable amount of radiation, the author recommends conservative treatment of acute variceal hemorrhage. Transhepatic portal venous embolization should be used only in patients in whom endoscopic sclerosis has failed and in whom there is reason to believe a selective splenorenal shunt can be successful.