Aortic Aneurysm and Dissection Care in Singapore

Dr Andrew Choong is a vascular, endovascular and aortic surgeon in Singapore who assesses and treats aortic aneurysms, aortic dissection and aorto-iliac blockage at Mount Elizabeth Novena Specialist Centre, with surgery performed across Singapore's private hospitals. This page explains what each condition is, how it is assessed, when watching is the right plan and when repair is advised, and how to arrange a planned consultation or a second opinion on scans you already have.

Aortic guides on this site

Each operation and each decision has its own detailed page. Start with the one that matches your situation.

Treatments

• EVAR: abdominal aneurysm repairStent-graft repair of an abdominal aortic aneurysm through the groin arteries; who it suits and what follow-up it needs.
• TEVAR: thoracic aortic repairStent-graft treatment of aneurysm, dissection and injury in the chest aorta.
• Fenestrated and branched EVARCustom and off-the-shelf stent-grafts for aneurysms that involve the kidney and gut arteries.
• Open aortic surgeryReplacing the diseased aorta with a surgical graft; when it remains the better choice.
• Aortic arch repairOpen, frozen elephant trunk, hybrid and endovascular approaches to the arch.
• Aortic stent surveillanceWhy scans continue for life after EVAR and TEVAR, and what they look for.

Conditions and decisions

• EVAR vs open repairThe 15-year trial evidence, why NICE and the ESVS differ, and how anatomy and fitness decide.
• Thoracoabdominal aneurysmCrawford extents, open and endovascular repair, and protecting the spinal cord.
• Heritable aortic diseaseMarfan, Loeys-Dietz, bicuspid aortopathy and familial aneurysm: thresholds, genetics and screening relatives.
• Endoleak after EVAR"My aneurysm is leaking?" The five types, which are watched and which are fixed.
• Aortic second opinionWhat scans and records to send, how they are reviewed and what a review can settle.
• Abdominal aortic aneurysm screeningA one-off ultrasound for people at risk; who should consider it and what happens next.

What are the main types of aortic disease?

Aortic aneurysm

An aneurysm is an abnormal enlargement of part of the aorta. It may involve the chest (thoracic aorta), the abdomen (abdominal aorta) or both. Normal dimensions and treatment decisions differ between these segments. Assessment considers the aneurysm's size, growth, shape and symptoms alongside individual risk.

Many aneurysms cause no symptoms. Potential complications include rupture with internal bleeding, or clots travelling downstream and obstructing blood flow. Finding an aneurysm does not automatically mean surgery is needed.

Aortic dissection

A dissection occurs when blood enters a tear in the inner lining and separates the layers of the aortic wall. It can interrupt blood supply to organs or limbs and may lead to rupture. A new dissection requires hospital assessment. Its location and complications determine whether urgent surgery, endovascular treatment or closely monitored medical treatment is appropriate. A dissection that has been treated medically is followed with scans, because the weakened aorta can enlarge over years into a post-dissection aneurysm.

Aorto-iliac occlusive disease

Narrowing or blockage of the lower aorta and iliac arteries can reduce blood flow to the legs. Symptoms may include pain when walking, pain at rest or wounds that fail to heal. This overlaps with peripheral arterial disease and needs a circulation assessment.

Watch: Aortic aneurysm vs dissection: what is the difference? · Read: Aortic awareness and family conversations

How is an aortic problem assessed?

Assessment brings together your symptoms, examination, medical and family history, and imaging. Ultrasound can assess an abdominal aneurysm. CT angiography provides detailed information for most aortic problems and for repair planning; MRI or echocardiography may be appropriate for particular questions.

Previous scans help establish whether the aorta is changing, so bring or send them. Kidney function, heart and lung health, medication and daily activity also matter when weighing treatment risks. Bring available scan images and reports, a medication list and details of previous vascular procedures to a planned consultation.

What treatment options are available?

Surveillance and medical care

A stable aneurysm below the repair threshold is monitored with scheduled imaging rather than repaired immediately. Medical care addresses relevant risks, including blood pressure and smoking. The interval between scans depends on the diagnosis and measurements. Surveillance is an active plan: it needs a next review and clear advice about symptoms that require urgent help.

Endovascular repair: EVAR and TEVAR

Endovascular repair places a stent-graft inside the aorta through the blood vessels. EVAR usually refers to abdominal aneurysm repair; TEVAR treats suitable disease in the thoracic aorta. The graft provides an internal channel for blood flow. Suitability depends on the aortic anatomy and access vessels, and ongoing imaging remains important after repair. Read EVAR: a pipe within a pipe for a practical explanation of the technique and why it is not suitable for every aneurysm. For aneurysms that involve the kidney and gut arteries, see fenestrated and branched EVAR.

Open and hybrid surgery

Open repair replaces the affected aortic segment with a surgical graft. Selected complex problems need a combination of open and endovascular techniques. The choice balances the risk of the untreated condition against treatment risks, durability and follow-up needs. Recovery varies with the operation, urgency and your health. The aortic arch repair guide explains open, frozen elephant trunk, hybrid and selected endovascular approaches, and our guide to EVAR vs open repair sets out the trial evidence and the anatomy and fitness factors that decide which repair suits whom.

Dr Choong's ASVS 2025 reflections on open aortic surgery explain why a range of approaches remains relevant to individual care. His publications and book chapters on complex aortic repair include work on thoracoabdominal aneurysms, visceral debranching and hybrid reconstruction.

Watch: Complex aortic aneurysms: why planning matters · Read: Thoracoabdominal aneurysm guide

Aortic consultation and second opinions in Singapore

A planned consultation or second opinion can help you understand a diagnosis, compare surveillance and repair options, and discuss an existing treatment recommendation. Many second-opinion requests concern an aneurysm that has been called "too complex" or "unsuitable" for a standard repair, a recommendation to operate that the patient wants checked, or a repair done elsewhere that now needs surveillance or has shown an endoleak.

Scans can be reviewed before you travel. Our aortic second opinion guide explains exactly what to send (the CT images themselves, not just the report), how the review is done and what it can and cannot settle. Dr Choong's participation in international research on inherited aortic disease is documented by his named collaborator credit in a 2024 Journal of the American Heart Association study.

For non-emergency appointments at Andrew Choong Vascular Surgery, Mount Elizabeth Novena Specialist Centre, contact the clinic. Acute warning symptoms belong in emergency care: call 995.

Aortic disease videos

Watch Dr Andrew Choong explain EVAR for aortic aneurysms and aortic dissection warning signs, the difference between an aortic aneurysm and an aortic dissection, and why complex aortic aneurysms need detailed planning. Browse the aortic video collection for screening discussions and a longer public awareness talk.

Common questions about aortic care

Which specialist treats an aortic aneurysm in Singapore?

Aortic aneurysms below the chest are treated by vascular surgeons; aneurysms of the aortic root and ascending aorta are usually treated by cardiothoracic surgeons, and the arch and thoracoabdominal aorta often by both working together. Dr Choong is a vascular and aortic surgeon who performs open, endovascular and hybrid repair and works with cardiothoracic colleagues for disease that involves the heart end of the aorta.

At what size is an aortic aneurysm repaired?

For an abdominal aortic aneurysm, repair is generally considered at about 5.5 cm in men and 5.0 cm in women, or earlier if it grows quickly or causes symptoms. Thoracic thresholds are higher and depend on the segment and the cause; thresholds are lower in some heritable conditions. Size is the main factor but not the only one: shape, growth rate, symptoms and your fitness all count.

Should I ask about screening if I feel well?

Screening depends on personal and family risk, including age, smoking history and the type of aortic disease in relatives. A general age rule is not appropriate for every patient. Read about aortic aneurysm screening and individual risk, or explore aortic awareness and family conversations. See our abdominal aortic aneurysm screening service for assessment and appointment information.

Does a repair end the need for follow-up?

No. Follow-up checks the repair and any remaining aortic disease. After a stent-graft repair, scans continue for life, because an endoleak or a change in the aorta above or below the graft can develop years later. Ask which scans you need, when they are due and what changes should prompt earlier review. Read about aortic stent surveillance.

Can I get a second opinion on my aortic scans without travelling first?

Yes. The CT images, previous reports and any operation notes can be sent ahead and reviewed before you decide whether to travel. The second opinion guide lists what to send and how.

Is aortic disease hereditary?

Some is. Abdominal aneurysms run in families, and first-degree relatives of someone with an aneurysm are usually offered an ultrasound. Thoracic aneurysm and dissection at a young age, or with particular features, may point to a heritable condition such as Marfan or Loeys-Dietz syndrome. Our heritable aortic disease guide explains who should be assessed and how relatives are screened.

Related guides: aortic aneurysm screening, and aortic aneurysm repair cost in Singapore with the Ministry of Health fee benchmarks for the surgeon's fee.