Angiogenesis is a critical process in the treatment of cardiac ischemic injury, and numerous research findings indicate that macrophages play a vital role in angiogenesis. This review summarizes how macrophages regulate angiogenesis through the secretion of key factors and the interactions with other cells. M1 macrophages promote new blood vessel formation in the early stages by secreting pro-angiogenic factors, while M2 macrophages are involved in vascular remodeling and maintaining vessel homeostasis. This review also discusses several new therapeutic strategies for promoting angiogenesis, including direct injection of macrophages, modulation of macrophage phenotype and function, and the use of macrophage-derived exosomes. Numerous studies have shown that macrophages have multiple functions in angiogenesis, and targeting macrophages provides new therapeutic targets and directions for promoting angiogenesis and treating ischemic diseases.