Aortocaval fistula (ACF) after rupture of an abdominal aortic dissecting aneurysm is a rare emergency situation, which has a high mortality. However, the diagnosis is usually delayed, which increases the difficulties of treatment. We describe a case that successfully delayed use of endovascular aneurysm repair (EVAR) for ACF resulting from rupture of abdominal aortic dissecting aneurysm.We describe a special case of a 70-year-old male with an abdominal aortic dissecting aneurysm rupturing into inferior vena cava (IVC). On account of his atypical presentation, the diagnosis had been delayed for half a year. Due to severe metabolic sequelaes of the ACF and preexisting conditions, the traditional open repair was too risky. Minimally invasive EVAR was performed with a successful result. There were no endoleak or fistula at the follow-up of 9th month.EVAR is the most suitable method in patients with ACF from rupture of abdominal aortic dissecting aneurysm. Further educational programs should be developed, which may give rise to earlier diagnosis and treatment with better outcomes.