Carbohydrate structures are involved in numerous biological activities such as inflammation, and cell adhesion/migration/proliferation. This gives the rationale for the design of vascular targeted drug delivery systems bearing sugar moieties. For the imaging and treatment of vascular diseases, an overview is presented with polysaccharides targeting vascular components. After a general description of the vasculature and the main blood components, a special emphasis is placed on carbohydrate-based molecules, such as heparin/heparan sulfate, and carbohydrate-binding proteins, such as selectins found in the vascular system. The methods using heparin and heparin analogs in delivery systems applied to vascular components are then described.