A 69 year-old male with a right common iliac aneurysm perforating into the inferior vena cava was admitted with severe cardiomegaly and dyspnea. He had been suffering from recurrent congestive heart failure for the last 8 years prior to surgery. At operation, the fistula of 15mm diameter was closed with interrupted sutures of 3-0 nylon with pledgets within the aneurysm by controlling bleeding from the fistula by digital compression. The right common iliac aneurysm was resected and replaced with a double velour knitted dacron graft of 10mm diameter. The postoperative course was uneventful. The CTR was reduced to 57% from 70%, and the cardiac index was normalized from 6.10 to 3.39 l/min/m2. This complication is rare with only 4 previous reports in Japan. Hemodynamic improvements were dramatic after surgery in spite of poor response to medical treatments. This complication should be surgically managed as soon as the diagnosis is confirmed.