Surgical Repair of an Arteriovenous Fistula in the Posterior Wall of the Right Common Iliac Vein

We present the case of a right internal iliac artery aneurysm with arteriovenous fistula in the posterior wall of the right common iliac vein. The fistula would have been difficult to close using endovascular treatment. We strongly anticipated difficulty in controlling bleeding; therefore, we performed cardiopulmonary bypass. Closing the fistula with suture would have been difficult, so we ligated the right common iliac artery and vein around the aneurysm. Femoro–femoral bypass was also performed to preserve blood flow in the lower right leg. The use of cardiopulmonary bypass should be considered in such difficult cases.