Introduction

As the afternoon sun slanted across the table, casting long shadows in a quiet room, Professor Zhang Baigen settled in for a long conversation. Over cups of tea that were poured and cooled, then poured again, the 85-year-old surgeon began to recount the history of his field. “When you get older,” he mused, a gentle smile crinkling the corners of his eyes, “the past feels as clear as yesterday.”

As a layperson in the world of vascular surgery, I was there to listen. And so, for an entire afternoon, Professor Zhang painted a vivid picture of a bygone era—the struggles, the breakthroughs, and the unyielding spirit of the surgeons who, under the stark glare of operating room lights, forged a new medical discipline in China.

A Nascent Field: The Early Struggle for Recognition

“In the history of medicine, vascular surgery is a young discipline,” Professor Zhang began, his voice steady and reflective. “It started late, and its initial development was slow.”

Globally, vascular surgery only began to take shape in the late 19th century, with major progress coming in the mid-20th century. In China, its beginnings were even more modest. For decades, vascular diseases were a fragmented specialty. Conditions of the heart and major chest vessels were handled by cardiothoracic surgery, those in the brain by neurosurgery, while diseases of the neck, limbs, and abdomen fell under the broad, often overburdened, umbrella of general surgery. This scattered approach stymied professional growth and created a scarcity of dedicated experts.

A key early visionary was Professor Lan Xichun of Renji Hospital. A pioneer of Chinese cardiac surgery, Professor Lan authored the nation’s first textbook on cardiovascular surgery in 1963, with a dedicated volume on vascular surgery that became an essential reference for future generations. “He had the foresight to see that vascular surgery needed to be its own independent system,” Professor Zhang shared.

Professor Lan made two attempts to establish a dedicated vascular unit at Renji, once before and once after the 1970s, but both were hampered by historical constraints, a lack of trained personnel, and limited technical mastery.

The turning point for Professor Zhang came in 1979. After returning from a medical aid mission to Morocco, he found China at a pivotal moment. The nation was calling to “reclaim the lost 17 years,” a reference to the period of the Cultural Revolution. The field of surgery was beginning to specialize. When Renji Hospital’s general surgery department identified five new directions, Zhang chose the one that “no one wanted”: vascular surgery.

“At that time, only a handful of hospitals in the country were performing vascular surgeries, and there were no systematic standards,” he recalled.

His resolve was cemented during a fellowship in Lyon, France, from 1980 to 1987. Sponsored by the Sino-French Association, he worked at Hôpital Édouard Herriot and conducted research at INSERM (the French National Institute of Health and Medical Research). There, he witnessed a mature, independent specialty with a well-established technical framework. He returned to China determined to build the same at home.

An Unlikely Alliance: The 1983 Milestone

A surprising and pivotal moment arrived in November 1983. The Professional Committee of Peripheral Vascular Diseases of the Chinese Integrative Medicine Association was established in Xi’an, marking the first significant academic organization for the field in China. Professor Zhang was in attendance.

“The circumstances were rather dramatic,” he recalled with a chuckle. A doctor named Ni Zheng, who had previously visited Zhang’s department to learn, was the committee’s secretary. Shortly after leaving Shanghai, he invited Zhang to the conference in Xi’an. On the train, Zhang ran into colleagues from another Shanghai hospital who were also attending, a serendipitous encounter that underscored the field’s desperate need for a community.

At the conference, Zhang and two other Western-trained surgeons, Sun Jianmin and Feng Youxian, were invited to give keynote presentations. Although the society was rooted in Traditional Chinese Medicine (TCM), its inclusive nature provided a crucial platform for the burgeoning field. At the time, TCM had shown remarkable success in treating thromboangiitis obliterans, while Western medicine excelled in areas like angiography and prosthetic grafting.

“The first committee was mostly composed of TCM doctors, but we were all moved by their open-mindedness,” Zhang said. This model of “East-West complementarity” laid the foundation for the discipline’s future integration and growth.

Forging an Identity: The Birth of a Specialty

The momentum continued to build. In 1987, the Chinese Medical Association (CMA) held a symposium on peripheral vascular diseases in Yantai, which was retroactively recognized as the first annual meeting of the Vascular Surgery Group. The group was formally established in 1993 at a conference in Beijing, a milestone that marked the official independence of vascular surgery from general surgery.

Professor Zhang had been a vocal advocate for this change. In a 1992 article titled “The Developing Field of Vascular Surgery,” he argued, “Vascular surgery must become a specialty.” His call resonated. That same year, Renji Hospital became one of the first in the country to establish an independent vascular surgery unit.

At the 1993 CMA meeting, Academician Wang Zhonggao was elected as the first chairman, with Professor Zhang and Dr. Wang Yuqi as vice-chairmen. The new group set clear goals: to promote angiography, standardize surgical procedures, and advance the domestic production of vascular grafts. A group photograph from the event perfectly captured the transition: the veterans of general surgery sat in the front row, while the young, ambitious vascular surgeons stood in the back.

Professor Zhang has always believed that collaboration is the bedrock of progress. Starting in the late 1980s, he freely shared angiograms and surgical videos with visiting doctors, even when some colleagues worried about “technology leakage.”

“As it turned out, this openness accelerated the formation of a national vascular surgery network,” he said. “By the year 2000, most major tertiary hospitals had established their own vascular departments.”

Three Great Leaps Forward

Reflecting on this journey, Professor Zhang identifies three pivotal “leaps” that defined China’s rise in vascular surgery:

The Technological Leap: Moving from a subset of general surgery to an independent discipline with its own comprehensive technical system.

The Academic Leap: Progressing from the integrative medicine society to the CMA’s official group and then to international academic forums.

The Talent Leap: Transitioning from isolated “one-man departments” to a nationwide, professionalized workforce.

A prime example of the academic leap was the creation of the National Venous Surgery Forum. Observing that arterial surgery was dominating academic attention, Professor Zhang championed the idea that “venous surgery should be given equal importance.” After two years of preparation, the first forum, hosted by Professor Wang Shenming, was held in Guangzhou in 2003. The second, hosted by Renji Hospital in 2005, drew over 300 scholars. Now in its tenth iteration, the forum stands as a testament to two decades of significant advancement in the treatment of venous disease in China.

The Next Horizon: A Legacy of Innovation

As our conversation drew to a close, Professor Zhang’s gaze turned to the future. He is confident that the next generation of surgeons will carry the torch with broader vision and a more inclusive spirit. He outlined several key areas for future growth:

Embracing Precision and Intelligence: The future will be defined by technologies like AI-assisted diagnostics, 3D-printed vascular models, and nanorobots. The goal is to develop domestic medical devices and move towards less invasive, non-surgical treatments.

Breaking Down Boundaries: Complex conditions like diabetic foot or tumor-related vascular invasion require multidisciplinary collaboration. Closer integration between vascular surgery, endocrinology, oncology, and even TCM is essential.

Expanding Access to Care: Advanced technology must not be confined to major urban centers. A national collaboration network using telemedicine and standardized training can bring life-saving care to rural and underserved communities.

Leading on the World Stage: China is now poised to move from follower to leader. He hopes to see more young scholars presenting innovative research at international forums and leading multinational studies to establish standards for Asian populations.

Nurturing the Next Generation: The future of the discipline depends on young doctors who possess both the “craftsman’s spirit” to master their skills and the “scientist’s mind” to challenge conventions. Above all, they must remember that vascular surgery is not just an art, but a sacred trust.

“Today, vascular surgery is a fully integrated discipline of clinical practice, teaching, and research,” Professor Zhang concluded, his voice filled with a quiet pride. “But we must remember our history. The regrets of pioneers like Professor Lan, the loss of early records, the lessons from academic competition—they all remind us to cherish our legacy. If future generations write this history, I hope they will not only record the technical triumphs but also remember the names of those who quietly paved the way.”

As the last rays of the sun faded, the story of a discipline was etched not just in memory, but as a guiding light for the future.

About Professor Zhang Baigen

Professor Zhang Baigen(86 years old) is a pioneering vascular surgeon and a key figure in the establishment and development of vascular surgery as an independent specialty in China.

Founder: A principal founder of the Vascular Surgery Department at Renji Hospital, Shanghai Jiao Tong University School of Medicine, which became a national key discipline.

Leadership: Former Vice Chairman of the Vascular Surgery Group of the Chinese Medical Association (CMA) and Vice Chairman of the Professional Committee of Peripheral Vascular Diseases of the Chinese Integrative Medicine Association.

International Experience: Trained in vascular surgery at Hôpital Édouard Herriot and INSERM in Lyon, France (1980-1987).

Academic Contributions: Served as an editorial board member and contributing author for multiple editions of the national textbook Surgery.

Honors: Recipient of the Lifetime Achievement Award from the Chinese Integrative Medicine Association and the Highest Honor Award from the Chinese Medical Doctor Association. He is also a recipient of the State Council Special Allowance.