Since the discovery of vascular endothelial growth factor (VEGF), therapeutic angiogenesis has attracted interest as an alternative treatment for ischaemic heart and peripheral disease. In parallel, the view has also gained ground that angiogenesis has an important role in the pathogenesis of atherosclerotic disease and its clinical sequelae. These conflicting perspectives have both been based on a large quantity of preclinical data obtained from mainly small rodent models of disease. However, in recent years further research and the results of clinical trials of pro-angiogenic and anti-angiogenic treatments have provided new insights into the impact of VEGF and other angiogenesis-based approaches on human health and disease. This review discusses therapeutic angiogenesis in the light of recent scientific advances and clinical evidence, and considers the future challenges and prospects for therapeutic angiogenesis.