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Significance: A long-standing challenge of the blood vessel tail artifacts along the axial direction prevents optical coherence tomography angiography (OCTA) for a comprehensive three-dimensional (3D) vascular mapping. Addressing the blood vessel tail artifacts issue will make OCTA to be a real 3D blood vessel structural imaging technique, which in combination with OCT-based blood flow velocity measurements will pave the way for a simpler and robust 3D imaging of the capillary transit time, one important parameter for the evaluation of micro circulation. Approach: We first described the basic principles of OCTA imaging, discussed the origin of blood vessel tail artifacts in an OCTA image, then reviewed the existing OCTA techniques for tail artifacts suppression, and at last we envisioned the potential solutions for effective OCTA tail artifacts suppression. Results: The origin of blood vessel tail artifacts is due to the multiple scattering of photons with flowing red blood cells, which elongates the light path of the dynamic signal from vessel lumen to the tail regions. High numerical aperture implementation, subtraction-based post-data processing, Hessian filtering, and high acquisition rate-based dynamic analysis methods have been proposed to address the blood vessel tail artifacts issue in OCTA. Conclusions: High acquisition rate-based dynamic analysis in combination with Hessian filtering have the potential to effectively suppress the blood vessel tail artifacts and in the meantime preserve flows in small vessels within the tail region, providing real 3D OCTA imaging of blood vessel structures.