A fistula between the innominate artery and the esophageal substitute in the substernal space developed nine years after esophagectomy for esophageal carcinoma. Frequently, the patient had massive bleeding from the fistula. A permanent iliosubclavian arterial bypass was made using a prosthetic Dacron graft. Resection of the innominate artery and a part of the esophageal substitute including the fistula was followed by reconstruction of the esophageal substitute with jejunal free graft. The internal mammary artery and the left brachiocephalic vein were used for recipient vessels. The operation was successful and the postoperative course was uneventful.