Ruptured iliac artery aneurysm presenting as acute right heart failure and cardiac arrest.

Aortocaval fistula due to aneurysmal degradation can result in obscure clinical signs but with life-threatening sequelae. Our patient presented with multiple cardiac arrests because of sudden right heart decompensation after a ruptured iliac aneurysm into the adjacent iliac vein. He fully recovered after emergency open surgical repair. High awareness with subtle clinical signs is of great importance.