Small bowel vascular lesions, including angiectasia, Dieulafoy’s lesion are the most common causes of small bowel bleeding. They usually manifest as a chronic, well-compensated gastrointestinal bleeding but may also present with massive bleeding. Small bowel capsule endoscopy (SBCE) is of paramount importance to establish diagnosis, location, and severity of disease. Subsequent device-assisted enteroscopy with thermal or mechanical hemostasis can be used to control active bleeding or to improve anemia necessitating blood transfusion. Pharmacological treatments can be considered for patients who have not responded well to other types of treatment or in whom endoscopy is contraindicated. Only in highly selected cases, interventional radiology approaches or surgical resection can be considered. Clinicians should understand the characteristics of each type of small bowel vascular lesion, and the differences in their epidemiology, pathology, and clinical presentation. The selection of the appropriate method of diagnosis and therapy of these lesions and the timing for their clinical application are fundamental to improve the clinical outcome of patients.