This paper proposes a vessel active contour model based on local intensity weighting and a vessel vector field. Firstly, the energy function we define is evaluated along the evolving curve instead of all image points, and the function value at each point on the curve is based on the interior and exterior weighted means in a local neighborhood of the point, which is good for dealing with the intensity inhomogeneity. Secondly, a vascular vector field derived from a vesselness measure is employed to guide the contour to evolve along the vessel central skeleton into thin and weak vessels. Thirdly, an automatic initialization method that makes the model converge rapidly is developed, and it avoids repeated trails in conventional local region active contour models. Finally, a speed-up strategy is implemented by labeling the steadily evolved points, and it avoids the repeated computation of these points in the subsequent iterations. Experiments using synthetic and real vessel images validate the proposed model. Comparisons with the localized active contour model, local binary fitting model, and vascular active contour model show that the proposed model is more accurate, efficient, and suitable for extraction of the vessel tree from different medical images.