Ferroptosis is a newly discovered form of iron-dependent cell death caused by excessive lipid peroxidation. It is widely involved in a variety of pathological processes in the body and has been considered to be related to the development and treatment of various diseases. The study of extracellular vesicles has also advanced significantly over the past ten years, transitioning from a field of fundamental biological study to one with significant clinical implications. It is also presently actively investigating its potential use as a brand-new drug delivery system, combination therapy, etc. Research on ferroptosis mediated by extracellular vesicles has made progress in disease treatment. Given this, this review will focus on the association of extracellular vesicles with ferroptosis and the role that it mediates in the disease. Firstly, a description of ferroptosis' primary mechanisms is provided. Secondly, the pathways associated with ferroptosis and extracellular vesicles are elaborated, with attention to the relevance of the corresponding mechanisms to disease and potential applications for therapeutic use. Finally, future expectations and challenges of targeting the extracellular vesicle-mediated ferroptosis pathway in disease treatment are discussed.