The tumor vasculature plays a crucial role in promoting tumor growth and metastasis, showcasing heterogeneity in terms of tissue composition, functionality, and structural characteristics. The main limitation of traditional anti-tumor therapy arises from the disordered occlusion and structural abnormalities present within the vascular network of the tumor, which create a bottleneck effect. Hence, the advancement of nanomedicine techniques targeting the tumor vascular system offer a fresh and exciting direction for the treatment of cancer. In this review, the intricate dynamics between the tumor microenvironment (TME) and the tumor vasculature is explored with a focus on the functions of hypoxia, increased angiogenic factor expression, and inflammatory cytokines in the TME. Furthermore, this review provides a comprehensive analysis of various vascular-related treatments, delving into the mechanisms behind each approach. Specifically, the recent advancements in nanomedicines targeting for therapeutic strategies are highlighted, namely anti-tumor angiogenic therapy, tumor vascular structure disruption, tumor vasculature normalization, and embolization therapy. Lastly, an overview of the challenges and prospects associated with tumor vascular therapy using nanomedicines is presented.