Iliac arteriovenous fistula (AVF) usually manifests in a wide range of symptoms similar to typical deep venous thrombosis (DVT), which often lead to delayed diagnosis or misdiagnosis. We reported a 51-year old woman who was performed lumbar discectomy and showed a progressive abdominal distention, dyspnea, and swollen left leg. She was initially diagnosed as deep vein thrombosis and the fi nal diagnosis was arteriovenous fistula. Th e fistula was successfully sealed by an endovascular covered stent. No further recurrence was found aft er a half year's follow-up. Th is article summarized the experience regarding iliac arteriovenous fistula misdiagnosed, and discussed the differential diagnosis between arteriovenous fistula and pulmonary thromboembolism caused by deep vein thrombosis.