Ectopic varices pose a significant clinical challenge due to their rarity and complex vascular anatomy. Effective management requires a multidisciplinary approach, with interventional radiology playing a key role. While endoscopy remains the first-line tool for gastrointestinal bleeding, it is not always effective in these type of complications, being endovascular intervention often required. When TIPS is contraindicated, alternative treatments such as antegrade transvenous obliteration (ATO) and retrograde transvenous obliteration (RTO) offer effective options. Tailored approaches based on anatomical location and hemodynamic characteristics ensure optimal patient outcomes.