Automated retinal vessel segmentation plays an important role in the diagnosis of some diseases such as diabetes, arteriosclerosis and hypertension. Recent works attempt to improve segmentation performance by exploring either global or local contexts. However, the context demands are varying from regions in each image and different levels of network. To address these problems, we propose Pyramid Context-aware Network (PCANet), which can adaptively capture multi-scale context representations. Specifically, PCANet is composed of multiple Adaptive Context-aware (ACA) blocks arranged in parallel, each of which can adaptively obtain the context-aware features by estimating affinity coefficients at a specific scale under the guidance of global contextual dependencies. Meanwhile, we import ACA blocks with specific scales in different levels of the network to obtain a coarse-to-fine result. Furthermore, an integrated test-time augmentation method is developed to further boost the performance of PCANet. Finally, extensive experiments demonstrate the effectiveness of the proposed PCANet, and state-of-the-art performances are achieved with AUCs of 0.9866, 0.9886 and F1 Scores of 0.8274, 0.8371 on two public datasets, DRIVE and STARE, respectively.