Arterial aneurysm and dissection (art-A/D) is an emerging vascular complication of vascular endothelial growth factor signaling pathway inhibitors (VSPIs). However, the magnitude of this risk remains uncertain. The aim of this study was to quantify the VSPI-associated risks of art-A/D and aortic aneurysm and dissection (ao-A/D) among adults with solid tumors. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. We systematically searched MEDLINE, Embase, CENTRAL, and Web of Science databases from inception through July 31, 2026. Four comparative studies, comprising randomized and observational studies, were included for quantitative synthesis of the relative risk of VSPI use. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated with a random-effects model using the Paule-Mandel estimator, yielding art-A/D (RR, 1.46; 95% CI, 1.08–1.97) and ao-A/D (1.74; 1.31–2.31). The elevated risks remained robust across alternative variance estimators and in leave-one-out and cumulative analyses. VSPI therapy was associated with an increased risk of art-A/D and ao-A/D. These findings support careful management, including baseline assessment of underlying vascular conditions, continuous clinical monitoring, and urgent diagnostic workup upon the onset of suggestive symptoms.