A 50-year-old male patient, a known case of chronic obstructive pulmonary disease with ischemic cardiomyopathy and renal failure, was admitted to the hospital with acute breathlessness. He was drowsy and unable to maintain oxygenation on noninvasive ventilation. He was put on invasive ventilation and he got better. A spontaneous breathing trial was tried several times, but he could not be weaned off the ventilator for 10 days. Percutaneous tracheostomy (PCT) was planned. During pre-procedure assessment, a pulsation was palpated over the area of incision raising the suspicion of a high-riding innominate artery.