Arterial embolization is the best treatment for pancreaticojejunal anastomotic bleeding after pancreatoduodenectomy.

Massive pancreaticojejunal anastomotic bleeding, mainly from the gastroduodenal stump, is one of the most common complications of pancreatoduodenectomy. Selective angiography should be systematically the first step of investigative procedure in such situations. Pharmacoarteriography may be used if the bleeding point is not spontaneously identified, and allows safe and effective treatment with transcatheter arterial embolization compared to blind open surgical hemostasis. Coil embolization of the common or proper hepatic artery on either side of the bleeding point with "sandwich technique" is then the preferred technique to prevent retrograde filling. Surgery should be performed only as a last resort.