Study Objective The purpose of this video is to review a case of severe pelvic congestion and uterine arteriovenous malformations (AVMs) that was managed operatively with uterine artery embolization followed by immediate hysterectomy. Our objectives include: • Review the risk factors, diagnosis, and treatment of uterine arteriovenous malformations. • Describe the clinical course of a patient referred to our MIGS clinic for uterine artery embolization and hysterectomy. • Consider postoperative expectations for a patient after embolization and hysterectomy for pelvic congestion syndrome and AVMs. Design This is a case report. Setting Interventional radiology operating room and robotic operating room. Patients or Participants 41yo patient referred to our clinic from an interventional radiologist for surgical treatment of severe pelvic congestion syndrome with an intrauterine arteriovenous malformation. Interventions Uterine artery embolization and robotic-assisted total laparoscopic hysterectomy Measurements and Main Results N/A Conclusion Our case report emphasizes that uterine artery embolization before hysterectomy can help decrease blood loss for severe pelvic congestion syndrome and known AVMs. To achieve these favorable outcomes, coordination with interventional radiology, anesthesia, and the OR staff is necessary.Postoperatively, patients may have a fever due to the uterine artery embolization. Additionally, pelvic fluid collections may be due to inflammation and increased blood flow to the area due to the known pelvic congestion. These postoperative changes may present similarly to a pelvic abscess, but our patient was successfully managed expectantly.