A case of a reflex sympathetic dystrophy syndrome (RSD) asscciated with the internal iliac arterio-venous fistula was reported. The patient was a 36-year old woman, and had the left oophorectomy at 21-year old and the lumbar laminectomy at 36-year-old. She complained of coldness and paresthesia of the right lower extremity 14 days after the lumbar laminectomy. A stenosis or occlusion of the arteries in both legs were not demonstrated by arteriogram. The coldness and paresthesia disappeard after the epi-dural block. RSD of the right leg was diagnosed which occurred at the lumbar laminectomy. Lumbar sympathectomy (L2∼L4) was performed simultaneously with closure of the internal iliac arteriovenous fistula. Postoperative clinical course was uneventful. Symptoms we were immediately disappeared. Sympathetic ganglion block has same efficiency as lumbar sympathectomy. Therefore sympathetic ganglion block is more suitable if patient has RSD only.