We report the case of a 32‐year‐old woman who presented 18 months after a laparoscopically assisted vaginal hysterectomy (LAVH) with symptoms of high‐output cardiac failure due to an internal iliac arteriovenous fistula. This was diagnosed by the presence of classical physical signs and confirmed by flush aortography. The fistula was obliterated at open surgery. We discuss this rare complication and the role of LAVH compared with open hysterectomy