Recent experimental studies showed that angiogenesis can be stimulated by administration of angiogenic growth factors or supplementation of angiogenic stem cells. After extensive investigation in preclinical studies and recent clinical trials, therapeutic angiogenesis has been established as a potential method to salvage ischemic myocardial and limb disease patients who have no therapeutic options in current medicine. The safety and tolerability of therapeutic angiogenesis by gene transfer has been demonstrated in phase I clinical trials, and although early phase II studies of angiogenic gene therapy demonstrated limited evidence of efficacy, adequately powered, randomized, placebo-controlled phase II and III clinical trials will determine the utility of therapeutic angiogenesis by gene transfer. Supplement-side therapeutic angiogenesis by administration of angiogenic stem cells, especially endothelial progenitor cells from bone marrow, showed marked efficacy in both ischemic myocardial and limb disease in early phase II clinical trials. Endothelial progenitor cells not only support angiogenesis, but are also suggested to transdifferentiate into cardiomyocytes which might replace the lost myocardium. This review focuses on the use of angiogenic genes, protein, or adult stem cells for the treatment of ischemic cardiovascular disease and contrasts how far we have come in a short time with how far we still need to go before therapeutic angiogenesis becomes routine in cardiovascular medicine.