<p>The purpose of this study was to evaluate the clinical history and hemodynamic changes of type B aortic dissection (TBAD) during 10 years of CTA-based imaging follow-up after thoracic endovascular aortic repair (TEVAR), with 12-year clinical follow-up, in a single patient. A 59-year-old TBAD patient was enrolled in this single-case longitudinal retrospective analysis. The patient initially presented with a thrombosed thoracic and patent abdominal dissection and was treated with optimal medical therapy. However, the patient underwent TEVAR 6 months later for a newly developed thoracic aortic dissection. The patient was followed up with serial computed tomographic angiography (CTA) for 10 years after TEVAR and by clinical follow-up for 12 years. Reintervention was performed for a distal stent-graft-induced new entry tear. We reconstructed the CTA images into three-dimensional models to measure the area and volume of the true lumen and false lumen and performed hemodynamic simulations using computational fluid dynamics to measure the pressure, wall shear stress, and blood-flow velocity within the true and false lumens. The area and volume of the true lumen increased postoperatively. The postoperative false lumen pressure gradually decreased and it dropped below the true lumen pressure in the 7th and 10th postoperative years. Focal areas of high wall shear stress were observed at branch/bifurcation or curved segments and in compressed true-lumen segments. There was a decrease in wall shear stress and velocity in the true lumen after TEVAR. In this single patient, TEVAR was associated with altered pressure distribution, including a relative increase in true-lumen pressure, and with decreased wall shear stress and blood-flow velocity in the true lumen. These findings are hypothesis-generating and should not be generalized without validation in larger cohorts.</p>