Arteriovenous (AV) fistula is one of Vascular anomalies with direct and indirect communication between arteries and veins without the interposition of a capillary bed. While some malformations arteriovenous are congenital, most are post-traumatic or iatrogenic. Serious complications such as bleeding, bacterial superinfection, and recurrent ulcerations can occur. We present the case of a 42-year-old male admitted to the hospital with active bleeding from the right leg and worsening since + 3 weeks ago. He had a history of gunshot wound in popliteal region about 5 years ago and history of vein stripping due to chronic venous insufficiency in his leg 11 months ago. On the examination from his left lower leg, there was an active ulcer; the ulcer looked reddish and whitish, with active bleeding, he complained about the sensation of pain. The laboratory tests examined leukocytes: 14,460. CT Angiography of Lower Extremities with intravenous (IV) contrast revealed a left superficial femoral arteriovenous fistula (AVF). There was vein dilatation of the left superficial vein until the left common iliac vein, and vein dilatation of the lower left extremity superficial veins until the distal part of the leg. Focal eccentric thrombus was shown in the left common iliac vein resulting in moderate stenosis. Intraoperative, We did a hybrid procedure with a combination of endovascular procedure using balloon assisted to identify the AV Fistula lesion and open surgery to repair the lesion. After four weeks the ulcer healed.