ObjectiveWomen in vascular surgery, especially those in leadership positions, are historically sparse but have the potential to make significant contributions to diversifying the future cohort of vascular surgeons. We aimed to analyze the current demographics of integrated vascular surgery residency (0+5) and fellowship (5+2) program directors (PDs) in the United States. MethodsA cross-sectional study of all active Accreditation Council for Graduate Medical Education-accredited 0+5 and 5+2 programs was performed. Program and PD data were obtained in February 2023 using publicly accessible sources. Program accreditation date, affiliation type, female faculty, and female trainees were collected. PD data included medical degree, training pathway, country of training, gender (male vs female), current age, appointment age, duration between training and appointment, research output, and H-index. ResultsSeventy-four 0+5 programs and 117 5+2 programs were included. Most programs were university-affiliated (164/191; 86%). Seventy-six percent (146/191) of PDs were identified as male, with the remaining 24% female. The mean age was 52 ± 7 years, and the age at PD appointment was 46 ± 7 years. The time between training completion and PD appointment was 11 ± 7 years, and the mean term length was 4 ± 3.5 years. Female PDs were younger overall (49 ± 6 vs 53 ± 7 years; P = .04) and at age of appointment (41 ± 5 vs 48 ± 7 years; P = .03). There was a trend of female PDs having longer term lengths compared with male PDs (6 ± 4 vs 4 ± 3 years; P = .08). Forty percent of residents were female, and 26% of full-time faculty were female. 5+2 female PDs were in programs with more female faculty (P = .001). Female department leaders had double the number of female PDs compared with male department leaders. Male PDs had a higher mean number of publications and Hirsch index compared with female PDs. However, these differences were not statistically significant when adjusting for age and age at position appointment. ConclusionsMost 0+5 and 5+2 PDs were men, and the overwhelming majority of department or division leaders in vascular surgery were male. Although the majority of PDs were male, female PDs were appointed earlier in their career. The current state of diversity in vascular surgery leadership has improved over the past decade; however, there still needs to be more female vascular surgeons, especially in leadership positions. Continuing institutional and societal efforts to recruit female trainees and promote women to leadership is essential to improve the diversification of vascular surgeons.