Abstract:Chronic aortocaval fistula (ACF) is a rare complication of gunshot wounds to the abdomen, and poses a difficult problem to diagnose. It's also known as bursting heart syndrome. We report a 43 years old man diagnosed with ilio-caval fistula secondary to bullet abdominal injury 23 years ago. The diagnosis was delayed, hence his symptoms at presentation were due to high output heart failure. An endovascular technique was done successfully. Chronic aortocaval fistula (ACF) is an infrequently reported sequel of trauma and CHF in a young male patient. History of penetrating abdominal trauma should alert the surgeon to this rare complication. To note that most of these cases have been repaired via open approach.