“No two days in vascular surgery are ever the same. A planned aneurysm repair in the morning can give way to an emergency limb salvage by noon. That unpredictability is what keeps it alive.”
Written by Dr Rahul Agarwal, Consultant Vascular & Endovascular Surgeon
CARE Hospitals, Banjara Hills, Hyderabad
People often ask me what a vascular surgeon actually does on a typical day. The answer is that there is no typical day — and that is precisely what drew me to this specialty. Let me walk you through a real working day, the kinds of decisions I make, and what it feels like to work at the intersection of surgery and technology in modern India.
🌅 07:30 AM — Ward Rounds
The day starts with ward rounds. I check on patients who had surgery the previous day or night — reviewing their pulse status in the operated limb, wound appearance, blood tests, and drain outputs. Post-operative vascular patients need close monitoring because even a small change in pulse can signal an early graft thrombosis that needs immediate action.
A typical morning round might include a patient who had an AV fistula created the previous day, a diabetic foot revascularisation who went to theatre overnight, and a carotid endarterectomy patient who is almost ready for discharge.
💉 08:00 AM — The Operating Theatre
Mornings are largely surgical. A typical operating list might include:
- An AV fistula creation — a 45–90 minute procedure connecting a forearm artery to an adjacent vein to create dialysis access
- A lower limb angioplasty for a diabetic patient with a blocked tibial artery — performed in the cath lab / hybrid theatre under X-ray guidance, usually taking 1–2 hours
- An endovenous laser ablation for varicose veins — a day-case procedure taking 30–45 minutes
On major surgical days, a list might include a femoral-popliteal bypass or an EVAR (endovascular aortic repair) — cases that take several hours and involve a multidisciplinary team including anaesthesia, scrub nurses, radiology technicians for fluoroscopy guidance, and an active circulating nurse.
🏥 01:00 PM — OPD (Outpatient Consultations)
Outpatient clinic is where I see new referrals and follow-up patients. On a typical day I might see 15–25 patients. The variety is remarkable:
- A 58-year-old diabetic with a non-healing foot ulcer sent by his diabetologist
- A 65-year-old man with newly diagnosed abdominal aortic aneurysm picked up incidentally on an ultrasound
- A 40-year-old woman with painful varicose veins affecting her quality of life
- A CKD patient referred early for AV fistula creation planning before starting dialysis
- A 70-year-old who had a mini-stroke and whose carotid duplex shows significant stenosis
Each consultation involves history-taking, examination of pulses in both arms and legs, and often a bedside duplex ultrasound assessment. Decisions about further imaging (CT angiography, MR angiography) or surgical planning follow.
🚨 The Unscheduled Part
The reality of vascular surgery is that emergencies don’t follow a schedule. During any given day, the phone might ring with:
- An emergency room patient with a cold, pulseless leg following arterial thrombosis
- A dialysis patient whose AV fistula has stopped working (thrombosed) and needs urgent intervention
- A trauma patient with vascular injury following a road traffic accident
- An ICU patient with a suspected ruptured aortic aneurysm needing emergency EVAR
Emergency vascular surgery requires the ability to move fast, think clearly under pressure, and make rapid decisions about operative strategy. It is what makes on-call in vascular surgery genuinely intense.
📚 The Academic Side
Beyond clinical work, a vascular surgeon’s day includes teaching junior residents, reviewing imaging, participating in multidisciplinary team (MDT) meetings with nephrologists, diabetologists, interventional radiologists, and wound care nurses, and staying current with rapidly evolving endovascular technology and literature.
❓ What I Find Most Rewarding
When a patient with a gangrenous toe walks out of hospital with their foot intact after a revascularisation procedure — that is the moment that makes the long hours worthwhile. Vascular surgery, perhaps more than any other specialty, offers the opportunity to literally save limbs and save lives on a weekly basis. That is a privilege that never becomes routine.
💡 Key Insight: A career in vascular surgery is intellectually demanding, technically challenging, and clinically high-stakes. For those who choose it, it is also deeply fulfilling — because the impact on patients’ lives is immediate and visible.
📖 Related Reading:
- How to Become a Vascular Surgeon in India
- What Does a Vascular Surgeon Do?
- What Is Vascular Surgery? The Complete Guide
About the Author 🧑🏻⚕️
Dr Rahul Agarwal is a Consultant Vascular & Endovascular Surgeon at CARE Hospitals, Banjara Hills, Hyderabad.