Objective: To evaluate the efficacy of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) for hepatocelluar carcinoma (HCC) with intrahepatic arteriovenous shunts (AVS). Methods: The clinical data of 45 HCC patients with intrahepatic AVS were retrospectively analyzed. In all patients, the AVS were identified by angiography or enhanced CT scan before operation. Patients underwent RFA first, followed by TACE two weeks later. At one month after operation, the patients received re-examination of the enhanced CT scan and AFP level to assess the degree of AVS occlusion and tumor ablation. Results: Operations were successfully performed in all patients. The overall disappearance and effective occlusion rate of the AVS was 28.9% and 77.8%, and the overall complete and effective ablation rate of tumor was 68.9% and 80%, respectively. In the 37 α-fetoprotein (AFP)-positive patients, AFP turned to be negative in 28 cases and AFP level declined in 9 cases. No serious complications occurred in any of the patients. Conclusion: RFA combined with TACE is an effective and safe approach for HCC with AVS.