This review explores the multifaceted role of extracellular vesicles (EVs) in angiogenesis, a process crucial for tissue oxygenation, nutrient distribution, and waste elimination. EVs, including exosomes, microvesicles, and apoptotic bodies, play a significant role in intercellular communication and modulating angiogenic signaling pathways. The review highlights the potential of EVs as therapeutic tools for both physiological and pathological purposes, such as enhancing cardiac function, promoting angiogenesis, and treating cardiovascular diseases. Key mediators of angiogenesis, such as VEGF, FGF, and PDGF, are discussed, along with the mechanisms by which EVs influence these processes. The review also addresses the advantages and disadvantages of EV-mediated angiogenesis, emphasizing the need for further research to understand the precise mechanisms and optimize EV-based therapies. Finally, the clinical applications of EVs in diagnosing and treating angiogenesis-related diseases are discussed, including their potential in bone regeneration and cancer therapy.This review explores the multifaceted role of extracellular vesicles (EVs) in angiogenesis, a process crucial for tissue oxygenation, nutrient distribution, and waste elimination. EVs, including exosomes, microvesicles, and apoptotic bodies, play a significant role in intercellular communication and modulating angiogenic signaling pathways. The review highlights the potential of EVs as therapeutic tools for both physiological and pathological purposes, such as enhancing cardiac function, promoting angiogenesis, and treating cardiovascular diseases. Key mediators of angiogenesis, such as VEGF, FGF, and PDGF, are discussed, along with the mechanisms by which EVs influence these processes. The review also addresses the advantages and disadvantages of EV-mediated angiogenesis, emphasizing the need for further research to understand the precise mechanisms and optimize EV-based therapies. Finally, the clinical applications of EVs in diagnosing and treating angiogenesis-related diseases are discussed, including their potential in bone regeneration and cancer therapy.