Blood loss due to acute gastro-intestinal bleeding is a frequent cause of admission in critical care units. Rapid diagnosis and effective treatment are the determinant prognostic factors. The initial therapeutic approach in the acute settings consists of combined medical and endoscopic treatment. The recurrence of haemorrhage and the development of haemorrhagic shock significantly increase morbidity and mortality, and depend on the extent of the lesion and on patient co-morbidities. Until recently, recurrent or refractory haemorrhage required urgent surgical therapy, which was associated with significant mortality. In the last years, the development of interventional radiology techniques has offered to clinicians an alternative, effective and less invasive therapeutic approach for the treatment of acute blood loss. In this article, we will show the outstanding role of interventional radiology in the treatment of acute gastro-intestinal bleeding.