Tracheo-innominate artery fistula[TIF] is the uncommon delayed fatal complication of tracheostomy. The mortality rate of the lesion, if not treated surgically, approaches 100%. A 64-year-old man presenting with a TIF after tracheostomy was treated by lateral repair and muscle interposition between the innominate artery and trachea. Preoperatively, bleeding was controlled by gauze packing around the tude under manual compression and hyperinflation of the balloon cuff of the tracheostomy tube. No abnormality was found by angiographic evaluation. The patient failed to regain consciousness and died 4 days later from sepsis.