Objectives Multiple organ failure is a rare manifestation of ilio-iliac arteriovenous fistula which can lead to a high rate of misdiagnosis and death. Methods We reported a 61-year-old man presenting with multiple organ failure rapidly after right lower limb swelling. Computed tomography angiography showed an ilio-iliac arteriovenous fistula caused by right common iliac artery aneurysm, and venous thrombosis of bilateral common iliac veins. A bifurcated stent-graft with coil embolization of right internal iliac artery was used for repair …