With the changing diet and aging population, especially since the 21st century, the incidence of peripheral vascular diseases, especially Peripheral Arterial Disease (PAD), is increasing at a rapid rate year by year, and the number of PAD requiring intervention is increasing and the condition is becoming more complex. Although the incidence of venous vascular disease is largely stable, the base is relatively large, and the dangers of thromboembolic disease cannot be underestimated, with the risk of pulmonary embolism receiving increasing attention. Vascular diseases are bound to seriously threaten our health and even life for a considerable period of time in the future. Vascular surgery is the main force in the treatment of peripheral vascular diseases. In the past 20 years, with the rise of domestic vascular endoluminal interventional technology, the development trend of vascular surgery has also moved from “mega-invasive” to “minimally invasive”. However, the development of vascular surgery in China is still relatively short, the overall foundation is weak, and there are still more problems and challenges. Clinical vascular surgery development opportunities and challenges coexist, compared with the opportunities, the challenges may be more. 1, the large base of PAD is the biggest opportunity It is well known that the most common pathological basis of PAD is atherosclerosis, the occurrence of which is closely related to hypertension, diabetes, hyperlipidemia and coronary heart disease. Cardiovascular diseases such as hypertension and stroke have become prominent public health problems in China. According to 2013 data from the China Center for Disease Control and Prevention, the prevalence of hypertension among people aged 15 years and older in China is 24%, and the number of hypertensive patients nationwide is 266 million, meaning that at least one in five adults suffers from hypertension. It is estimated that the national annual incidence of hypertension in adults over 40 years of age is about 3%, with at least 7 million strokes. The proportion of children and adolescents with high blood pressure in China has been on the rise, and has reached about 15%. The proportion of obese children with high blood pressure is about 30%. Hypertension accelerates the process of atherosclerosis, and atherosclerotic plaque can cause narrowing of carotid, renal and peripheral arteries, causing abnormalities in coagulation mechanisms and lipid metabolism, and aggravating peripheral vascular disease. Intermittent claudication is combined in 2% to 5% of hypertensive patients, and its prevalence increases with age. The risk of intermittent claudication increases 2.5 times and 4 times in male and female hypertensive populations, respectively, and its risk is proportional to the severity of hypertension. Meanwhile, 35% to 55% of patients with peripheral vascular disease are combined with hypertension.1 According to a rough estimate of 3%, the existing number of people with peripheral vascular disease in China is about 8 million. According to the latest survey by Chinese scientists, the prevalence of diabetes in Chinese adults is nearly 11.6%, and the prediabetes rate is 50.1%. In other words, there are about 113.9 million diabetics in China, and half of the adults are on the verge of diabetes. Using the ankle-brachial index as an indicator, foreign data show that about 20% of diabetics >40 years of age have combined PAD, while the figure is as high as 29% in diabetics >50 years of age.2 Thus, based on a base of about 113.9 million diabetics in China, the number of people with PAD must be as high as more than 20 million. Smoking is also an important cause of PAD. China is still a big smoking country, and although the development of smokers has been controlled by tobacco control and anti-smoking activities in recent years, the base of smokers is still huge, of which the incidence of PAD cannot be accurately counted, but a high proportion is certain. The large population has created a huge source group of vascular diseases, which provides excellent conditions for the exploration of the etiology and pathology of vascular surgery, the application of new technologies and methods, the training of skilled personnel, and the development of personalized treatment. This is a good opportunity unmatched by other countries abroad. 2, the introduction of new technology and new equipment update more and more timely and efficient minimally invasive surgery is the inevitable trend of vascular disease treatment, which must rely on the catheter guidewire technology, new balloons, stents or suction embolism equipment according to demand in the continuous update, development. With the deepening of China’s reform and opening up, the international cooperation and exchange in vascular surgery is becoming more and more frequent. The introduction of new technology and new equipment in China is becoming more and more vigorous and timely, and new products appearing abroad can generally be tried out in China within a short period of time, so that domestic doctors can keep up with the pace of international technology and concepts in a timely manner. At present, except for the peripheral vascular drug-coated balloon which has not yet been applied in China, drug-coated stents, Viabahn overlay stents3, AngioJet aspiration catheters4, Rotarex aspiration catheters5, SilverHawk plaque rotational catheters6, etc. have been widely applied in various units in China with good response. Large-scale international conferences such as CEC invite a large number of foreign experts to come to give lectures and share their lessons learned, or show recorded surgeries or direct satellite live broadcast, so that domestic scholars can absorb new knowledge and technology in a very timely and intuitive manner. These, all to the development of our vascular surgery to provide a valuable platform and opportunities. 3, the establishment of a nationwide vascular interventional training base In 2013, the Health Planning Commission approved more than 50 vascular interventional training bases, which established a good platform to promote the healthy development of minimally invasive vascular surgery in China, to standardize the training of cardiovascular surgery clinicians, strengthen business learning, and constantly master new knowledge and expand new areas of treatment. There is still a gap between the overall level of minimally invasive vascular surgery in China and the international level, and the development of vascular surgery, especially the minimally invasive technology, is still unbalanced. It is necessary for the central cities to drive the development of the surrounding areas, carry out more technical training, train more professional physicians, and properly carry out vascular surgery technology. The establishment of training bases allows vascular surgery interventional techniques to be more standardized and specialized on the basis of continuous promotion and development. This is also a great opportunity for the overall development of vascular surgery in China. 4, the lack of independent research and development innovation and clinical application of the lack of opportunities in front of us at the same time, the challenge is also very serious. Although there is the continuous introduction of new foreign technology, but China still lacks independent innovation of core technology, which is our biggest development bottleneck. If it has been like this, we will always follow behind others, just learn a new technology, there may be a newer technology out, overwhelmed, difficult to fight. Although some domestic balloons have been clinically validated in our department and other sister departments recently, the core technology is still introduced from abroad, and even the simple catheter guide wire and guide sheath can not be produced in China at present, which is really worrying. The problem lies in our lack of independent research and innovation on the one hand, and more importantly, the lack of clinical application of our translation. A good idea of clinicians cannot be reflected in the clinic quickly and quickly, and there is a lack of support from the corresponding clinical translation team. Compared with the traditional catheter sheath, it adds a guidewire inlet and outlet, and designs a small balloon between the two guidewire outlets, after the balloon is dilated, the guidewire can be placed separately, thus it can treat at least the proximal and distal femoral artery at one time. This allows for the treatment of lesions in at least two directions at one time, reducing the number of treatments and improving the therapeutic effect. In addition, the utility model can be used for retrograde puncture in patients with either paracentral puncture or retrograde puncture, and then the guidewire can be left at the proximal exit, and the catheter sheath can be fixed after the balloon is dilated and then the guidewire can be followed to the distal exit into the superficial femoral artery, which can significantly improve the success rate of puncture technique and reduce the complications of puncture. On the one hand, clinicians are not good at dealing with manufacturers, and on the other hand, manufacturers are not interested in products with small sales volume and little market value. Thus, the invention was put on the shelf. Recently, the application of similar foreign products was published in international journals7 and the value of our innovation was buried, which is a pity. However, domestic scholars have continued to pay attention to the transformation of clinical applications, and on April 8, 2013, the first clinical implantation of the “Castor Branching Aortic Closure Stent and Delivery System” of Minimally Invasive Heart and Vein Medical Technology was successfully completed in Changhai Hospital of Second Military Medical University, and the Castor Closure Stent was used for intracavitary treatment of thoracic aortic coarctation. The clinical study on clinical safety and efficacy of the Castor Overmolded Stent for the treatment of thoracic aortic coarctation was carried out. The application of this stent allows most of the aortic arch diseases to be completed through minimally invasive interventions, avoiding the huge trauma of traditional open-heart surgery. The country really needs such a relatively strong team of companies that support the innovation of our vascular surgeons to push our country to the forefront of the world. In fact, domestic experts and manufacturers in the above areas have sufficient capacity, but currently do not do enough. 5, the lack of multicenter cooperation, treatment guidelines are not standardized and evidence-based medicine is not taken seriously Challenges also come from within our vascular surgeons. At present, the overall development of vascular surgery in China is still uneven, coastal and inland, southern and northern, in terms of diagnosis and treatment, there is still the phenomenon of individual warfare, the lack of multi-center cooperation. There are only a few clinical epidemiological research studies on multicenter vascular surgical diseases. For example, the morbidity and mortality of pulmonary embolism mostly refer to foreign data, while domestic data are either unknown or inaccurate and difficult to adopt. Large national-level international conferences have emerged, but no more standardized Chinese treatment guidelines for peripheral vascular disease have been developed, making it impossible for each unit to implement diagnosis and treatment mainly based on their own environmental conditions and experience, and to reach different conclusions on efficacy, or to meet the requirements of multicenter cooperation. Based on the nationwide vascular interventional training bases that have been developed, it is advisable to now standardize and rationalize the consultation and treatment operations of each base so that more professional and collaborative vascular interventional professionals can be trained. Not only that, we should also put more emphasis on evidence-based medicine. Not only should we update the results of foreign clinical validation, but we should also get more evidence of our own clinical trials, not only by conducting retrospective studies, but also by conducting multicenter high quality prospective clinical studies. Report the study results to the international medical field to reflect our level, after all, we have a larger sample size and will certainly be more convincing. The newly conducted clinical validation of EINSTEIN-PE for pulmonary embolism prevention treatment also has the participation of domestic units, which also reflects the importance of foreign scholars to our large sample. 6. Gap with Leipzig model The Leipzig University Hospital in Germany has the most prestigious vascular disease treatment center in the world. 50 beds can complete more than 6,000 cases of peripheral vascular endoluminal interventions every year, which is the unit that carries out the largest number of cases, and the data is still being refreshed every year, and has become the mecca of vascular endoluminal interventions in the world. The center is currently the highest level of minimally invasive vascular intervention in the world, with world-class minimally invasive intervention specialists, and accepts 40-50 doctors from all over the world, including the United States, Europe and Asia, for mid- and long-term training every year. It also conducts 1-day short-term training for interventional specialists from Europe on certain techniques from time to time. The center also hosts a worldwide conference on minimally invasive vascular interventions (LINC) once a year in January and once a year in March, with 3-5,000 participants at each conference and hundreds of demonstrations of difficult interventional procedures broadcast live by satellite. The development of the Leipzig Interventional Center is less than a decade old, but the reason for its rapid growth depends on the advanced equipment and technology and the high level of specialized physicians, but more importantly, on its advanced scientific and open management model. From this point of view, China’s vascular surgery and the international level there is still a considerable gap, when the emergence of China’s Leipzig has no timetable. 7, the patient’s knowledge of the disease is still inadequate Compared to cardiovascular diseases, the development of vascular surgery in China is lagging behind, which the patient’s lack of knowledge of the disease is also related. The domestic public for causing death and disability rate of cardiovascular disease awareness is high, such as myocardial infarction, stroke, etc. has been deeply rooted in people’s hearts, coupled with the higher incidence rate, so that patients pay great attention to these diseases, the census rate is also high. Peripheral vascular disease incidence ratio is relatively low compared to cardiovascular disease, the disability rate of death rate is relatively low, still belongs to a niche disease, and even some patients do not know what specific vascular surgery is to see the disease, in the eyes of the people the importance of the limbs is much lower than the heart and brain and other important organs. Some scholars have used new terms similar to heart attack such as “foot infarction” to draw the attention of patients, but the effect is only a glimpse. In addition, the problem of long-term restenosis after PAD treatment10 has led to multiple visits to the doctor, and some patients are still unable to avoid amputation or even death, which further confuses the patients’ perception of the disease. Some physicians often exaggerate the effect of treatment in order to get patients to receive interventional treatment, neglecting to inform patients about the problem of long-term restenosis, which causes misunderstanding among some patients with restenosis and creates a situation unfavorable to the dissemination of disease knowledge. The publicity of related diseases is also not in place, and the rate of census work is low, failing to make patients understand the danger of peripheral vascular diseases and the importance of preventive treatment of vascular diseases, such as the role of treatment of carotid stenosis to prevent re-stroke, the lack of awareness of restenosis problems that may miss the opportunity of second recanalization, and the prevention of pulmonary embolism9. Foreign countries have done a relatively good job of disease awareness, for example, awareness of thromboembolic diseases has reached the level of self-prevention, and long-distance flights will carry their own low-molecular heparin subcutaneous injection to prevent venous thrombosis. Improve the awareness of patients is also to ultimately maximize the benefits to the majority of patients. 8.Looking to the future Intervention is the trend, open technology cannot be lost There is no doubt that minimally invasive vascular intervention has become the overall trend of future development, with the continuous emergence of new technologies and methods, almost all vascular diseases can be completed with minimally invasive intervention, but likewise, not all vascular diseases can be completed with intervention. As a vascular surgeon, open surgical techniques still cannot be lost, which is the basis and backing of interventional surgery. Combining traditional surgery with minimally invasive intervention, “both hands must be grasped and both hands must be hard”, in order to better serve patients. It is suggested that the vascular interventional training base should add surgical training programs. Looking ahead, the opportunities and challenges for the development of vascular surgery in China coexist, both can be transformed into each other, and the challenges are also the source of impetus for future development. Only by facing challenges and overcoming them can China’s vascular surgery be at the forefront of the world, and the “Leipzig of China” can emerge as soon as possible.