¹Türkiye Yüksek İhtisas Hastanesi Kardio vask üler Cerrahi Kliniği, Ankara Sixty-seven years old, male patient who had abdominal and back pain was referred to our clinic with a diag­ nosis of abdominal aortic aneurysm (AAA). With abdominal ultrasonography we detected an AAA that has a di­ ameter of 9x10 cm and a trombosed wall. We also detected congestion in the inferior vena cava and the hepa­ tic veins. We perfo'rmed digital subtraction angiography (DSA) and saw an AAA betwe en renal arteries and the aortic bifurcation. in the operation we closed the fıstula from inside of the aorta. Patients was discharged follo­ wing an uneventful postoperative period. Aorta-caval fistulas (ACF) end up with congestive heart failure and de­ ath. They can be asymptomatic; and then the only way of diagnosis is angiography or computerized tomography. in order to prevent irreversible cardiac and renal tailure, operation is essential. Delayed surgical interventionin­ creases morbidity and mortality. Keywords :