Aortic Second Opinion in Singapore: What to Send, How It Is Reviewed and What to Expect

Aortic decisions are rarely urgent in the way a ruptured aneurysm is urgent, but they are consequential: the choice between surveillance and repair, and between endovascular and open repair, shapes the next ten to twenty years of a person's life. A second opinion from a surgeon who performs the full range of aortic operations is a normal part of good care, not a sign of distrust. Most surgeons welcome it. This page explains how Dr Andrew Choong reviews aortic cases referred from Singapore and the region, what makes a review useful, and what it can and cannot settle.

When a second opinion is worth having

Some situations where an independent review adds the most:

• You have been offered repair of an abdominal or thoracic aneurysm and want to understand why that operation, at that size, now.
• You have been told you are "not suitable" for one type of repair and want to know whether a different technique (fenestrated or branched stent-graft, open repair, or a hybrid approach) changes that.
• You have had a stent-graft elsewhere and surveillance has shown an endoleak, sac growth or graft movement, or you have simply lost touch with follow-up.
• You have an aortic dissection being managed with medication and want to know when, if ever, intervention would be advised.
• Your aneurysm involves the renal or visceral arteries, the aortic arch, or extends from chest to abdomen (thoracoabdominal), where experience of the team matters most.
• You or a close relative have a connective-tissue or heritable aortic condition and the usual size thresholds may not apply.
• Two surgeons have already given you different advice.

What to send

The quality of a second opinion depends almost entirely on the quality of the imaging it is based on. A written report is a summary of someone else's interpretation; the decision is made on the pictures. Please send, in order of importance:

• The CT angiogram itself – the DICOM image files, on a CD/DVD, USB stick or a secure download link from the imaging centre or hospital. Not a PDF of selected images and not a photograph of a screen. If more than one scan exists, send all of them: growth over time is as important as current size.
• The radiology reports for each scan.
• Operation notes and the device details (make, model, sizes) if you have had any previous aortic or vascular procedure. The discharge summary usually contains this.
• Your current medication list and a short summary of other medical conditions, especially heart, lung and kidney disease, and any previous abdominal or chest surgery.
• Recent blood tests if available, particularly kidney function.
• Any letters from the surgeons or physicians you have already seen, so that their reasoning can be understood rather than guessed at.

Please do not send records, scans or identity documents through the website contact form. Call or message the clinic first and the team will explain how to share them through the appropriate channel.

How the review is done

Dr Choong reviews the imaging himself on dedicated vascular software, measuring the aorta in the correct plane (perpendicular to the centreline rather than on a standard axial slice, which can over- or under-estimate diameter), assessing the landing zones, branch vessels and access arteries, and comparing scans over time. The clinical history, fitness and your own priorities are then weighed against the anatomy. Where it helps, complex cases are discussed with colleagues in anaesthesia, cardiology or cardiothoracic surgery, and with international collaborators in the aortic community of which he is part.

For most people a consultation in person at Mount Elizabeth Novena follows, so that examination, further tests if needed and a proper conversation can take place. For patients overseas, the imaging review can begin before travel so that the visit itself is efficient.

Watch: Complex Aortic Aneurysms: Why Planning Matters · Read: Complex aortic aneurysms: assessment and treatment planning

What you will get back

A clear, written opinion in plain language covering: what the imaging shows and how it compares with previous scans; whether repair is advised now, later or not at all, and the reasoning; which repair options are anatomically and medically realistic for you, with their trade-offs; what surveillance would involve if you choose to wait; and the questions you may wish to take back to your existing surgeon. If the original advice was sound, the opinion will say so. A second opinion that always disagrees with the first is not worth having.

What a second opinion cannot do

Coming from outside Singapore

Dr Choong sees patients from across Southeast Asia and the wider region. The usual sequence is: records sent and reviewed first; where appropriate, a provisional view given by phone or video call; then a visit of a few days for consultation, any further imaging and, if repair is agreed, planning. Elective aortic surgery itself is scheduled separately, with time in Singapore after the operation that depends on the procedure. The clinic team can advise on the hospital's international patient services, estimates for insurers or embassies, and timing. Fees are governed by the insurance panels and schemes we participate in; a written estimate is provided once the treatment plan is clear. See insurance and payment and the consultation preparation guide.

How to start

Call or WhatsApp Dr Choong directly on +65 9027 8636, or contact the clinic team on +65 9376 8688 or enquiries@drandrewchoong.com. If Dr Choong is operating, the clinic team will respond. Tell us whether you are in Singapore or overseas, what you have been told so far, and what scans you have. Referring doctors are welcome to call directly; see referral information.

Sudden severe chest, back or abdominal pain, collapse, or a cold painful leg in someone with a known aneurysm or dissection is an emergency: call 995 in Singapore or go to the nearest emergency department. Do not wait for a second opinion.

Common questions about aortic second opinions

Will my current surgeon be offended?

Almost never. Second opinions are routine in aortic surgery, particularly for complex anatomy. A good surgeon would rather you proceed with confidence than with doubt, and many will help you obtain your records.

Can you give an opinion from the report alone?

Only a very limited one. Reports vary in how they measure and describe the aorta, and the key anatomical details for planning repair are often not recorded. The images are what matter.

How quickly can the imaging be reviewed?

Once the images have been received, a provisional view is usually possible within a few working days, sooner for patients with large or symptomatic aneurysms. The clinic team will tell you the expected timing when you make contact.

Do I have to have treatment with Dr Choong if I ask for a second opinion?

No. Many people take the opinion back to their own surgeon and proceed there. The review is independent of where you choose to be treated.

What if the two opinions differ?

The written opinion sets out the reasoning so that the difference can be understood rather than simply counted. Differences are often about timing or technique rather than whether repair is needed at all, and a conversation between the surgeons, with your permission, frequently resolves them.