<p>A pelvic arteriovenous malformation (AVM) is a rare congenital vascular anomaly that may cause relevant clinical symptoms. This systematic review synthesizes current evidence on diagnostic approaches, embolization techniques, and clinical outcomes for pelvic AVMs. A PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses)-compliant literature search identified 19 studies comprising 49 patients treated with embolization therapy. Venous approaches, including direct puncture of a dominant outflow vein (DOV), were most commonly performed. Coils were the primary embolic agent, frequently combined with adjunctive materials, reflecting substantial technical heterogeneity. Despite this variability, embolization achieved consistently high technical and clinical success rates with low complication rates over a mean follow-up of 21.1&#xa0;months. Embolization therapy of DOV may be considered as first-line therapy for symptomatic pelvic AVMs, although future comparative studies are needed to guide standardized treatment strategies.</p> Graphical Abstract <p></p>