An 82-year-old man presented with typical signs and symptoms of an arteriovenous fistula (AVF) associated with an aortoiliac aneurysm, such as a pulsatile abdominal mass, continuous bruit, thrill, and high output heart failure. Multidetector row computed tomography (MDCT) confirmed the presence of an AVF between the right common iliac artery aneurysm and vein. We subjected the patient to surgical repair of the AVF combined with graft replacement, which proved successful.