To explore the clinical characteristics, diagnosis and treatment strategies of primary aldosteronism (PA) complicated with arterial dissection, and to enhance awareness of vascular disease screening in PA patients. Methods Clinical data and diagnosis and treatment process of 3 cases with PA complicated with arterial dissection were retrospectively analyzed. The clinical features and therapeutic strategies of this disease were summarized, and discussed with literatures. Results Among the three patients, two were female and one was male, all under the age of 40 years old at onset. They were manifested as hypertension, hypokalemia with arterial dissection, but no significant cardiac disease. Plasma aldosterone concentration in all patients were significantly higher than 30 ng/ dl. The symptoms of case 1 and 2 were occult, while case 3 was manifested as sudden tearing pain in the chest, back, waist and right leg. After vertebral artery dissection stenting and adrenalectomy, all vertebral artery disease and PA were cured in the case 1 and 2. Their aneurysms were disappeared. Their quality of life was significantly improved. The case 3 was well controlled after surgery, stent replacement and spironolactone treatment. Conclusions Arterial dissection and aneurysms may be the earliest vascular complications of PA, especially in young patients. The symptoms are occult and difficult to be detected early. Therefore, early screening should be strengthened. For PA patients with confirmed arterial dissection and aneurysms, a comprehensive evaluation should be conducted to determine the treatment strategy for PA and vascular disease. A lifelong follow-up should be conducted to maximize the improvement of patient prognosis.