The primary role of adipose tissue (AT) is energy storage. Besides its critical role in energy homeostasis, AT is well recognized as an endocrine organ. Both the metabolic and secretory functions of AT focus attention upon the interactions existing between the blood compartment and the adipocytes and thereby the importance of the AT vasculature. In humans, the fat mass possesses a unique ability to grow and to develop throughout the life. The adipocyte changes its size dynamically according to the amount of lipid stored. Once hypertrophy is maximal, de novo adipocytes arise from the differentiation of adipocyte progenitor cells (ie adipogenesis)(Bjorntorp and Sjostrom 1972). Even if the number of adipocytes is considered to remain constant in adulthood, adipogenesis is essential for adipocyte turnover and maintenance of AT (Spalding et al. 2008). This AT plasticity requires constant vessel growth, regression, and remodeling. The present review describe the AT vasculature and its role in the control of AT metabolic and secretory activities in relation to AT blood flow. The potential mechanisms involved in the remodeling of the AT vascular system are exposed. Finally, the physiological and pathological consequences of the remodeling of AT vasculature are discussed.