The most important points in preventing innominate artery erosions following tracheostomy are proper placement of the stoma and selection of flexible tubes with appropriate low pressure cuffs. In tracheal resections the risk of a tracheo-innominate artery fistula can be reduced by avoiding damage to the adventitia of the artery fibrosed to the stenotic tracheal segment and by interposing tissue between artery and anastomosis. If haemorrhage occurs this can be controlled by hyperinflation of a cuffed endotracheal tube in most cases. Permanent control of this complication can be achieved by resection of the artery without interposing a vascular graft. No cerebral damage will result. A great number of patients can be saved by the timely institution of proper measures.