The recognition of vascular surgery as an independent surgical specialty is inevitable, but the pathway to full autonomy remains uncertain. Vascular surgery emerged from general surgery in the mid-1950s with the advent of synthetic grafts and microvascular techniques. By the early 1980s, Accreditation Council for Graduate Medical Education-approved fellowships were established in most large academic medical centers. The American Board of Surgery recognized this additional specialty training by awarding vascular graduates a Certificate of Special Qualifications distinguishing them from general surgeons. The emergence of endovascular surgery radically changed the face of vascular surgery from a general surgery subspecialty to a unique surgical specialty with a growing array of minimally invasive tools. With the establishment of a primary Certificate in Vascular Surgery and the subsequent development of integrated residencies, vascular surgery moved ever closer to recognition as an independent surgical specialty. Despite the remarkable progress that has been observed over the past 50 years, there is a desire in the vascular community for formal recognition of the unique body of knowledge and surgical skills that serve as the foundation of contemporary vascular care.