Angioectasias are the most common acquired vascular malformations of the gastrointestinal tract and a frequent cause of recurrent obscure or overt bleeding in older adults. In aortic stenosis, the associated von Willebrand defect defines Heyde syndrome, and although TAVI usually improves bleeding, persistence can occur. Argon plasma coagulation (APC) is the first-line endoscopic therapy, although certain locations pose substantial technical challenges. Pharmacological options in refractory cases remain limited; recent data suggest that bevacizumab, an anti-VEGF monoclonal antibody, may be promising, although real-world experience is still scarce. We report a 76-year-old male with severe aortic stenosis treated with TAVI, coronary artery disease, and chronic anaemia secondary to recurrent bleeding from intestinal angioectasias. Despite TAVI, he continued to experience recurrent melena, symptomatic anaemia and repeated hospital admissions. Von Willebrand factor levels and post-TAVI gradients were normal. Initial endoscopic assessments demonstrated multiple small-bowel angioectasias identified by capsule endoscopy and treated endoscopically with APC. Medical therapy with long-acting octreotide was also initiated at 10 mg/month and escalated to 60 mg/month, provided only transient symptomatic improvement; the patient remained transfusion-dependent and required frequent intravenous iron supplementation. During subsequent bleeding episodes, fresh blood was consistently observed in the second portion of the duodenum. Side-viewing duodenoscopy was therefore performed, allowing optimal visualisation of the papilla and revealing a major papillary angioectasia with persistent active oozing, while previously treated lesions showed no evidence of haemorrhage. The papillary angioectasia required multiple sessions of combined haemostasis—adrenaline injection, APC and clip placement—performed with a duodenoscope. Although haemostasis was achieved each time, recurrent bleeding from the same site persisted. Endoscopic papillectomy was considered but not pursued due to age, comorbidities and procedural risk. Given refractoriness to endoscopic therapy and maximal-dose octreotide, bevacizumab was initiated (5 mg/kg every two weeks). Treatment was complicated by uncontrolled hypertension and a pre-acute pulmonary oedema episode, both managed medically. A sustained response became evident only after completing the six-dose induction regimen, with stabilised haemoglobin, resolution of melena and cessation of transfusion and iron requirements. Papillary angioectasias represent a rare but challenging entity due to anatomical constraints, high bleeding potential and the risk of pancreatitis after intervention. This case illustrates successful bleeding control with combined endoscopic therapy and bevacizumab rescue after failure of intensive octreotide treatment. It highlights the potential role of VEGF blockade in highly refractory lesions and reinforces the need for individualised decision-making in complex angioectasias.