A 37-year-old woman was referred to our institute (Gynaecology Department) due to persistent metrorrhagia and raised serum β-HCG levels (126031 mU/ml). Patient gynaecological and obstetrical history was characterized by one prior term birth in 2012 and a spontaneous miscarriage at seven gestational weeks in 2016. The suspicion of gestational choriocarcinoma was raised as a highly vascularized uterine mass was detected at computed tomography. Gestational Choriocarcinoma is a highly malignant neoplasm of trophoblastic origin, characterized by rapid growth and high tendency to develop hematogenous metastases. Diagnosis is more commonly based on β-HCG serum levels and clinical presentation rather than on histopatological analysis (due to the high risk of bleeding following bioptical procedures). Thanks to its high chemosensitivity, gestational choriocarcinoma is usually associated with a good prognosis and high cure rates. The patient was submitted to a total body triphasic contrast-enhanced Multi Detector Computed Tomography (MDCT) confirming the presence of choriocarcinoma, but also showing a giant pelvic aneurysm suspecious for AVF, lung metastases and pulmonary thrombo-embolisms. The diagnosis of AVF was confirmed by a Color Doppler Ultrasound examination showing a typical arterialized, low-resistance blood flow of the pelvic veins. The case was discussed within a multidisciplinary gynaecological and radiological meeting. Following this, an angiography was planned in order to confirm the AVF diagnosis and to perform an embolization to stop the bleeding trying to occlude the fistula despite its large size. The decision on the opportunity to place a filter to prevent further episodes of pulmonary embolism was postponed until diagnostic angiograpy and embolization were completed. In an emergency setting, the patient was submitted to a diagnostic angiography initially using a right femoral transarterial and right femoral transvenous approach. Diagnostic arteriography confirmed the presence of a giant AVF sustained by branches of both hypogastric arteries with early opacification of the right gonadal vein and the inferior vena cava. After selective catheterization of right and left hypogastric arteries, using a coaxial microcatheter (Carnelian 2.2, Tokai, Medical Products, Sarayashiki Taraga Kasugay-city, Japan), the afferent branches to AVF were subsequently embolized using first detachable coils (Interlock, Boston Scientific, Natick, MA, USA) of variable diameter (6–14 mm) and length (10–40 cm), after poly vinyl alcohol (PVA) particles (Contour Embolization particles 500–710 μ, Boston Scientific, Natick, MA, USA) and finally also an ethylene-vinyl alcohol copolymer (EVOH)-based liquid embolic agent (Squid-peri 12, Emboflu, Gland, Switzerland) in order to reduce AVF in-flow. A transfemoral phlebography with selective catheterization of the right gonadal vein showed multiple thrombi, leading to the pulmonary embolism previously detected at the contrast-enhanced MDCT. Using a right transjugular approach, an Amplatzer plug was finally placed at the confluence of the right gonadal vein in the vena cava, not only to reduce AVF out-flow but also to occlude the right gonadal vein, preventing further episodes of pulmonary embolism. Metrorrhagia almost disappeared after the procedure. A contrast-enhanced MDCT examination performed 24 h after the embolization confirmed the correct placement of the plug and the significant reduction in volume and enhancement of the AVF. No further pulmonary embolism was demonstrated at MDCT performed during follow-up. A second transarterial embolization using the same embolic agents (PVA particles, coils and Squid) was performed six months later. The second embolization, combined with a complete response to systemic chemotherapy confirmed by β-HCG levels normalization with disappearance of pulmonary metastases, determined the complete AVF resolution. Currently the patient is aymptomatic and enjoys full well-being of health.