Angiogenesis is crucial for tumor growth and metastasis, and antiangiogenic drugs have been developed as first-line treatments in various cancers. While VEGF signaling pathways are commonly targeted, tumors can evade these therapies through alternative angiogenic mechanisms, including sprouting angiogenesis, vasculogenic mimicry, vessel intussusception, vascular co-option, cancer stem cell-derived angiogenesis, and bone marrow-derived angiogenesis. These mechanisms are not solely dependent on the VEGF signaling pathway and can lead to drug resistance. The article reviews these mechanisms and discusses the development of more effective antiangiogenic therapies, emphasizing the need for a deeper understanding of the molecular mechanisms of tumor angiogenesis to improve treatment outcomes.Angiogenesis is crucial for tumor growth and metastasis, and antiangiogenic drugs have been developed as first-line treatments in various cancers. While VEGF signaling pathways are commonly targeted, tumors can evade these therapies through alternative angiogenic mechanisms, including sprouting angiogenesis, vasculogenic mimicry, vessel intussusception, vascular co-option, cancer stem cell-derived angiogenesis, and bone marrow-derived angiogenesis. These mechanisms are not solely dependent on the VEGF signaling pathway and can lead to drug resistance. The article reviews these mechanisms and discusses the development of more effective antiangiogenic therapies, emphasizing the need for a deeper understanding of the molecular mechanisms of tumor angiogenesis to improve treatment outcomes.