The guided image filter (GIF) provides a useful tool for image processing. However, few works have tried to use GIF for vessel enhancement on medical images. This letter presents an efficient GIF based method for vessel enhancement, in which a weighted GIF (WGIF) is introduced by incorporating a contrast-aware weighting into GIF. The WGIF has the adaptive property, which enables it to achieve better performance in noise reduction and edge preservation. In addition, we assemble the multiscale vesselness measurement with the WGIF to produce stronger enhancement results on small and thin vessel structures. The proposed method achieves excellent results that illustrate its effectiveness.