Arteries in vivo are subjected to lumen pressure, shear flow and axial tension due to surrounding tissue tethering. The axial stress affects arterial function including its response to pressure and flow. While the effects of blood pressure and shear flow are well documented, the effects of axial tension on vascular remodeling have just gradually gained attention recently. This review summarizes the results on the observation of the axial tension in arteries and responses of arteries to elevation and reduction of the axial stress. It is concluded that the axial tension in arteries plays an important role in regulating normal arterial function and tissue remodeling and adaptation and disease development. Research on vascular remodeling under axial tension shall strengthen the understanding of normal physiological functions and pathological changes of the arteries.