Despite the improvements in medical, surgical and endovascular therapies, vascular disease is still a significant, critical clinical problem. The advances in understanding the mechanisms of neovascularization and the accumulated experiences of successful therapeutic application in animal models have raised expectations for therapeutic angiogenesis as a promising treatment option. However, the large, double-blinded, controlled clinical trials using therapeutic agent in the form of protein, naked DNA or viral gene therapy have failed to show clinical benefit. Nevertheless, by this time, cell based therapeutic angiogenesis has raised a promising option for the treatment of ischemic diseases. This article summarizes the essential preclinical research and major clinical trials on therapeutic angiogenesis, and it deals with several issues related to the failure of the clinical trials. Future directions in the realm of therapeutic angiogenesis are also described with focusing on cell based therapy.