Takayasu arteritis (TA) is a chronic granulomatous large-vessel vasculitis that primarily affects the aorta and its major branches, such as the subclavian, carotid, and renal arteries. Pathologically, it is characterized by transmural infiltration of lymphocytes and macrophages with granulomatous inflammation, leading to intimal fibrosis and thickening, destruction of medial elastic fibers, and subsequent luminal stenosis or occlusion. Aneurysmal dilation may occur in some cases. We here report a case of TA complicated by a vertebral artery dissecting aneurysm. Our patient was a 47-year-old male who had previously undergone surgical interventions at our institution for a common iliac artery aneurysm and splenic artery aneurysm 6 years and 2 years prior to the present admission, respectively. Most recently, the patient was presented with right shoulder pain and was subsequently diagnosed with a right vertebral artery dissecting aneurysm, for which endovascular intervention was performed. This case underscores the critical importance of long-term clinical surveillance in patients with TA, along with the necessity for aggressive treatment of aneurysms that are identified to have a high risk of rupture.