Overseas Vascular Opinion in Singapore: What Records Should You Send or Bring?

If you are travelling to Singapore for a vascular or aortic opinion, prepare your latest scan reports, the actual scan images where available, previous operation notes, discharge summaries, medication list, allergies and recent blood results. These records help the specialist understand what has already been found and what still needs assessment.

Dr Andrew Choong, vascular and endovascular surgeon at Mount Elizabeth Novena Specialist Centre, explains which information is particularly useful before a planned consultation. Good preparation can help the team distinguish an urgent problem from a review that can be arranged in advance.

Which records should I send or bring?

Gather the information relevant to your current vascular problem:

• Your latest ultrasound, CT or MRI report, with the scan date.

• The actual scan images, where available, as well as the written report.

• Previous operation notes and hospital discharge summaries.

• Details of previous stents, grafts, bypass surgery or other vascular treatment.

• Your current medication list, known allergies and recent blood-test results.

If some records are unavailable, let the clinic know what you have. The purpose is to build a useful clinical picture, rather than delay seeking help while trying to assemble a perfect file.

Why are the actual CT images important for aortic disease?

For an aortic aneurysm or other complex aortic condition, a measurement in a report is only part of the story. Planning also depends on where the disease begins and ends, the branch vessels, the access arteries and any previous stents or surgery.

The images help assess whether surveillance, an endovascular repair, open surgery or a hybrid approach may be appropriate. For example, fenestrated or branched EVAR requires detailed consideration of the anatomy. A scan report alone may not contain everything needed for that discussion.

What helps with leg wounds, swelling or vein problems?

For leg wounds, diabetic foot problems, varicose veins, DVT or leg swelling, clear photographs and previous vascular ultrasound or CT reports can add useful context. Include the records from earlier assessments or treatment when available. Photographs support preparation but do not replace an examination.

The vascular conditions overview and treatment guides explain the main areas of care and can help you prepare questions for the appointment.

Should I travel if symptoms are sudden or severe?

No. Seek emergency care locally first if symptoms are sudden or severe. Do not postpone urgent assessment while arranging an overseas consultation or waiting for a response about your records.

Plan your consultation in Singapore

For a planned specialist review, contact Andrew Choong Vascular Surgery to discuss the appointment and how to provide your records. The clinic is at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Watch the overseas-patient records video for Dr Choong’s explanation.

Complex Aortic Aneurysms: Why Planning Matters

Complex aortic aneurysm treatment begins with understanding the anatomy and the person, then comparing the risk of the aneurysm with the risk of treatment. The decision is more detailed than simply choosing a stent or open surgery.

In this video, Dr Andrew Choong, vascular and endovascular surgeon in Singapore, explains why early specialist assessment gives patients time to explore an appropriate strategy before an emergency develops.

What makes an aortic aneurysm complex?

An aneurysm is an abnormal enlargement of an artery. Aortic aneurysms may be complex when they lie close to important branch arteries, extend through both the chest and abdomen, have unusual anatomy, or occur after previous aortic surgery or stent-graft repair.

The branches supplying the kidneys and abdominal organs may affect where a repair can safely seal and how blood flow is maintained. Two aneurysms with similar diameters can therefore require very different plans. Our aortic disease guide provides the broader background.

What does careful planning involve?

Detailed imaging and measurements

Planning may involve CT imaging, three-dimensional reconstruction and precise measurements of the aorta and its branches. Previous scans and operation records are useful for understanding changes over time and any existing grafts.

Assessing overall health and priorities

Kidney function, heart and lung fitness, previous procedures and the patient’s goals all matter. The discussion should explain the likely benefits and risks of intervention, the alternative of surveillance, and the practical demands of recovery and follow-up.

Which treatment approaches may be considered?

The options depend on the affected part of the aorta and the individual anatomy:

• Fenestrated or branched repair: specialised stent grafts may incorporate openings or branches to maintain blood flow to important arteries. Some devices are custom manufactured for the patient’s anatomy. Read about fenestrated and branched EVAR.

• Open repair: open aortic surgery remains an important option when its balance of benefits and risks is appropriate.

• Hybrid approaches: selected cases may involve a combination of surgical reconstruction and endovascular treatment.

• Surveillance: monitoring may be appropriate when the risk of treatment outweighs the expected benefit of repair.

A more complex or custom device is not automatically the best choice. Suitability, treatment risks and the need for future review should be explained before a decision. After endovascular repair, ongoing stent-graft surveillance remains part of care.

Why seek an opinion before an emergency?

Planned review allows time to compare scans, consider different approaches and discuss the trade-offs. Seeking an early opinion does not mean that immediate surgery is necessary. It helps establish what should happen next and which changes should prompt earlier reassessment.

Sudden severe chest, back or abdominal pain, particularly with collapse or breathlessness, needs emergency assessment. Call 995 in Singapore and do not wait for a routine appointment.

Preparing for an aortic consultation in Singapore

Bring your scan images and reports, medication list and details of previous aortic procedures. For a planned assessment or second opinion, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre. You can also watch this explanation in the aortic video collection.

Aortic Aneurysm vs Aortic Dissection: What’s the Difference?

An aortic aneurysm is an abnormal enlargement of the aorta. An aortic dissection is a tear in its inner lining that allows blood to separate the layers of the artery wall. They can occur separately or together. Both can be serious, but the diagnosis, urgency and treatment are different.

In this video, Dr Andrew Choong, vascular and endovascular surgeon in Singapore, explains why these terms matter when understanding an aortic diagnosis.

What is an aortic aneurysm?

The aorta is the body’s largest artery, carrying blood from the heart through the chest and abdomen. An aneurysm develops when part of it becomes abnormally enlarged, rather like a balloon.

An aneurysm in the abdomen is called an abdominal aortic aneurysm, or AAA. One in the chest is a thoracic aortic aneurysm. Some cause no symptoms and are found during imaging for another reason. The concern is that the weakened section may enlarge and eventually rupture. An aneurysm diagnosis does not, however, mean it has already burst.

What is an aortic dissection?

With a dissection, a tear in the inner lining allows blood to track between the layers of the aortic wall. This creates a second channel called a false lumen, alongside the original blood channel.

A dissection can disrupt blood flow to important organs and can lead to rupture. It requires a different assessment from simply measuring an enlarged aorta. Our aortic disease guide explains these conditions in more detail.

Can you have one without the other?

Yes. As the video explains, you can have an aneurysm without a dissection, and a dissection without an aneurysm. They can also coexist. A previously dissected aorta may enlarge over time, so follow-up remains important even after the initial event has been treated.

Rupture is another distinct term: it means blood escapes through the wall of the aorta. Neither “aneurysm” nor “dissection” automatically means rupture has occurred.

Why does the difference change treatment?

Aneurysm care

A stable aneurysm may be monitored with scans and treatment of relevant risk factors. Whether repair is appropriate depends on its location, size, growth, symptoms and the person’s overall health. Not every aneurysm needs an operation immediately.

Depending on the anatomy, options may include endovascular aneurysm repair (EVAR) for suitable abdominal aneurysms, thoracic endovascular aortic repair (TEVAR) for suitable disease in the chest, or open aortic surgery. These approaches are not interchangeable for every patient.

Dissection care

Suspected acute dissection needs urgent hospital assessment. A dissection involving the ascending aorta near the heart usually requires emergency surgery. Some uncomplicated dissections confined to the descending aorta are initially managed in hospital with medication and close monitoring; complications may require intervention. The scan findings and clinical situation determine the plan.

When should you seek emergency help?

Call 995 in Singapore for sudden severe chest, back or abdominal pain, particularly with collapse, breathlessness or sudden weakness. These symptoms may signal an aortic emergency or another life-threatening condition. Do not wait for a routine clinic appointment. Read more about aortic emergency awareness.

Who should discuss assessment or screening?

If you have a known aneurysm, previous dissection, a relevant family history or an abnormal scan, discuss an individual assessment and follow-up plan. Screening is based on risk; the video’s advice to seek assessment should not be taken to mean that everyone needs a scan.

For non-emergency concerns, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, Singapore. Bring any previous scan reports so the discussion can focus on your diagnosis and options. If you already have an aortic diagnosis, see how to arrange an aortic second opinion and prepare your existing scans. You can also watch the short explanation in the video library.

Aortic Dissection Warning Signs: Think Aorta! Get a Contrast CT

Sudden severe chest, back or abdominal pain needs urgent emergency assessment. If you or someone with you has these symptoms, particularly with collapse, breathlessness or new weakness, do not wait at home or book a routine clinic visit. In Singapore, call 995 for emergency ambulance help.

In this video, ahead of Aortic Dissection Awareness Day, I explain why aortic dissection must remain a possibility when symptoms are sudden and serious. The message “Think Aorta” is a reminder to recognise the emergency and consider the diagnosis promptly.

What is an aortic dissection?

The aorta is the main artery carrying blood from the heart to the body. An aortic dissection occurs when a tear in its inner lining allows blood to enter and separate layers within the wall.

This can disrupt blood flow to important organs or limbs and can lead to other life-threatening complications. It is different from an aneurysm, which describes abnormal enlargement of an artery, although the two conditions can occur together. My aortic disease guide explains these differences in more detail.

What are the warning signs?

The classical symptom is pain that starts suddenly and is severe from the outset, often in the chest, back or abdomen. Some patients describe it as tearing or ripping; others describe the worst pain they have experienced.

However, you should not wait for a particular description of pain before seeking help. Aortic dissection does not always present in a textbook way, and a person may not use the words “tearing” or “ripping” at all.

Concerning features can include:

• Sudden severe chest, back or abdominal pain.

• Fainting, collapse or rapidly worsening illness.

• New weakness, difficulty speaking or other stroke-like symptoms.

• A sudden problem with circulation to a limb, such as pain, coldness or weakness.

These symptoms can also indicate other emergencies. The need for urgent care remains the same even when the exact cause is uncertain.

Why can aortic dissection be mistaken for something else?

In my video, I describe dissection as a clinical mimicker. Depending on the part of the aorta and its branches affected, it can resemble a heart attack, stroke, abdominal illness or limb circulation problem.

That is why the whole clinical picture matters. How suddenly did the symptoms start? Where is the pain? Are there changes in consciousness, movement or circulation? The emergency team brings these findings together rather than relying on a single symptom.

What does “get a contrast CT” mean?

When clinicians suspect an acute aortic problem, CT angiography is commonly used because it can rapidly show the aorta, the extent of a dissection and involvement of its branches. Contrast helps define the blood-filled channels and surrounding anatomy.

The phrase in my video is an awareness message about timely diagnosis. It is not advice for everyone with ordinary back pain to arrange a CT independently. The emergency team decides which imaging is appropriate, taking account of the clinical situation, stability, contrast history and other relevant factors. Alternative imaging may be needed in selected circumstances.

What should I tell the emergency team?

Describe when the symptoms began and whether they were sudden and severe. Mention known aortic disease, previous aortic procedures or a relevant family history if you know about them. Share your medication list and allergies when possible, without delaying the emergency call.

You do not need to prove that you have a dissection before asking for help. The priority is prompt assessment of a potentially serious event. Do not drive yourself if you are acutely unwell, and do not wait for a clinic message to be answered.

How is ongoing aortic care arranged in Singapore?

After an emergency has been assessed and treated, ongoing care may include blood-pressure management, specialist review and surveillance imaging. The plan depends on which part of the aorta is affected and the treatment already received.

For a non-emergency review of known aortic disease or a scan, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. You can also explore my aortic awareness information.

Awareness is useful when it leads to timely action: sudden, severe or otherwise concerning symptoms belong in an emergency assessment, not a period of observation at home.

September is Vascular Disease Awareness Month | Signs & Symptoms

Leg pain when walking, persistent leg swelling and wounds that heal poorly can be warning signs of vascular disease. Some blood vessel conditions cause few or no symptoms until they become serious. Recognising a change in your circulation - and knowing when to seek help - is the message behind this video.

September’s vascular disease and peripheral arterial disease awareness campaigns are an opportunity to talk about arteries, veins, blood clots and the aorta. In the video above, I introduce a series of short explanations about vascular health, the symptoms people sometimes overlook, and when a proper assessment may be needed.

What is vascular disease?

Vascular disease affects the blood vessels that carry blood around the body. Arteries carry blood away from the heart; veins return it. The aorta is the body’s main artery.

Vascular conditions include peripheral arterial disease (PAD), varicose veins, deep vein thrombosis (DVT), aortic aneurysms and aortic dissection. These are different conditions, so their symptoms, risks and treatments are not interchangeable.

Heart health and arterial health are closely connected. PAD and coronary artery disease share risk factors such as smoking, diabetes, high blood pressure and high cholesterol. Looking after these risk factors matters beyond the heart itself.

Which symptoms should you look out for?

The topics introduced in this Short cover several changes worth paying attention to:

• Leg pain when walking. Aching or cramping brought on by walking and relieved by rest can be a sign of peripheral arterial disease, where narrowed or blocked arteries reduce blood flow to the legs. Repeated symptoms should not automatically be put down to age or fitness.

• Swelling, aching or heavy legs. These may occur with varicose veins or other venous problems. Persistent swelling, skin changes or ulcers deserve assessment; visible veins alone do not establish how serious a problem is.

• Foot or leg wounds that are slow to heal. Poor healing can have several causes, including impaired circulation. A foot wound in someone with diabetes needs prompt medical attention.

• New swelling in one leg. Especially when accompanied by pain, tenderness or warmth, this needs urgent medical assessment for a possible deep vein thrombosis. DVT is a clot in a deep vein, and not everyone develops all the typical symptoms.

These signs are reasons to seek advice, rather than a way to diagnose yourself. Muscle, joint and other medical problems can also cause leg symptoms.

Can vascular disease be silent?

Yes. Some vascular conditions develop without obvious warning signs. For example, an abdominal aortic aneurysm often causes no symptoms. An aneurysm is an abnormal widening of an artery; an aortic dissection involves a tear in the inner lining of the aorta.

This does not mean everyone needs a scan. Whether an examination, circulation test or imaging is appropriate depends on your symptoms, medical history and individual risk.

When should you seek urgent help?

Seek emergency care now for sudden severe abdominal or back pain, sudden breathlessness or chest pain, fainting, or a limb that suddenly becomes cold, painful or numb. These symptoms can signal serious problems and should not wait for a routine clinic appointment.

In Singapore, call 995 for a life-threatening emergency.

When is a vascular assessment appropriate?

Arrange a medical assessment for persistent or recurring leg pain when walking, unexplained swelling, skin changes or a wound that is not healing. Mention any diabetes, smoking history, high blood pressure or high cholesterol.

An assessment helps determine whether your symptoms relate to the arteries, veins or another cause, and whether further tests are needed. New one-sided swelling or rapidly worsening symptoms require more urgent attention.

Follow the September vascular health series

In this introductory video, I set out the topics for the month: walking-related leg pain, poor circulation, diabetic foot wounds, varicose veins, blood clots, aortic aneurysms and aortic dissections.

September also includes Aortic Dissection Awareness Day on 19 September and World Heart Day on 29 September. The next Short starts with a commonly missed warning sign of PAD: leg pain when walking.

Vascular care in Singapore

For non-emergency concerns about your circulation, contact Andrew Choong Vascular Surgery to enquire about an assessment with Dr Andrew Choong, Consultant Vascular and Endovascular Surgeon.

The clinic is at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

This article expands on the accompanying video for general education. It does not replace an individual medical assessment or personal medical advice.

Vascular Surgery in 60 Seconds: Aorta, Arteries and Veins Explained

A vascular surgeon is a specialist in the blood vessels that carry blood around the body. In my 60-second video, I describe us as circulation doctors: we assess and treat problems affecting arteries and veins, using a range of medical, minimally invasive and open surgical approaches.

I am Dr Andrew Choong, a vascular surgeon in Singapore. Understanding the scope of vascular surgery can help you recognise why symptoms as different as walking pain, swollen legs and a wound that will not heal may need a circulation assessment.

What is the difference between an artery and a vein?

Arteries carry blood away from the heart towards the tissues. Veins return blood towards the heart. They are parts of the same circulation, but the conditions affecting them - and the tests and treatments they need - can be very different.

An artery narrowed by disease may not deliver enough blood to a muscle or wound. A vein with faulty valves may allow blood to pool in the leg. A blood clot can cause another kind of obstruction. The first job is to identify which problem is present.

Which conditions does a vascular surgeon treat?

Vascular surgery covers a broad range of circulation problems. The examples in my video include:

• Aortic disease: aneurysms and dissections affecting the body’s main artery.

• Leg artery disease: narrowed or blocked arteries that may cause walking pain, rest pain or poor wound healing.

• Venous disease: varicose veins and deep vein thrombosis.

• Carotid artery disease: selected artery problems in the neck relevant to stroke prevention.

• Dialysis access: creating and maintaining suitable access to the circulation for haemodialysis.

Wound care and limb preservation are also important parts of vascular practice. When poor blood flow contributes to a foot or leg wound, addressing the circulation may be one part of a wider treatment plan.

Is vascular surgery the same as cardiology?

The specialties are related, but their focus differs. Cardiologists primarily assess and treat the heart. Vascular surgeons mainly manage blood vessels outside the heart and brain, including the arteries in the neck and vessels throughout the body.

Some techniques overlap. Balloons, wires and stents can be used in both heart and peripheral vascular procedures. The presence of a stent does not, by itself, tell you which specialty or condition is involved.

Complex aortic and other vascular conditions may also involve several specialties working together. The appropriate team depends on the part of the circulation affected and the treatment required.

Does seeing a vascular surgeon mean I need an operation?

No. An assessment may lead to advice, medication, monitoring or further tests. For example, management of peripheral arterial disease can include cardiovascular risk reduction and structured exercise, with a procedure considered when clinically indicated.

For some patients, endovascular treatment offers a way to work inside a blood vessel through a small access site. Depending on the problem, this may involve a balloon, stent or another device. Other patients are better served by open surgery, such as a bypass or repair.

The decision starts with the diagnosis, symptoms, scan findings and goals of treatment. A procedure should have a clear purpose that the patient understands.

When should I seek a circulation assessment?

Persistent leg pain when walking, troublesome varicose veins, unexplained swelling or a wound that is not healing deserve medical attention. These symptoms have several possible causes, so an examination is more useful than assuming that every leg problem is vascular.

Some changes are emergencies. A suddenly cold, pale, painful or weak limb, sudden severe chest or back pain, or sudden breathlessness with collapse needs immediate emergency assessment. In Singapore, call 995 for severe emergency symptoms.

Where can I discuss vascular symptoms in Singapore?

You can contact Andrew Choong Vascular Surgery for a non-emergency consultation to discuss your symptoms, relevant scans and treatment options. My aim is to explain the circulation problem and the reasons for any proposed next step.

Current clinic location: Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

Aortic Dissection Awareness Day: Recognising a Vascular Emergency

Aortic dissection is a medical emergency in which blood enters a tear in the inner lining of the aorta and separates layers of its wall. Because the aorta supplies blood to the whole body, the consequences can develop quickly and involve more than the chest.

In this Aortic Dissection Awareness Day talk, published on 19 September 2024, I explain why recognising the possibility matters. I am Dr Andrew Choong, a vascular surgeon in Singapore. My message is to think about the aorta when symptoms and circumstances suggest a serious aortic problem, so that appropriate assessment is not delayed.

What happens during an aortic dissection?

The aorta is the main artery leaving the heart. It travels through the chest and abdomen, with branches supplying the brain, arms, abdominal organs and legs. Its wall is made of layers.

When blood tracks between those layers, it can disrupt blood flow to important branches. A dissection can also be associated with rupture or other life-threatening complications. The location and extent determine which organs are at risk and what treatment is needed.

A dissection is different from an aneurysm. An aneurysm is an abnormal enlargement of an artery; dissection refers to separation within the wall. Both fall within aortic disease, but they are not interchangeable terms.

Which symptoms should raise concern?

Sudden, severe chest or back pain is an important warning pattern, especially when the pain is at its worst from the beginning. Some people describe tearing pain, but that description is not essential. Abdominal pain or other symptoms may occur.

Depending on the branches involved, there may also be fainting, stroke-like symptoms, severe breathlessness or a painful, cold or weak limb. In the talk, I describe aortic dissection as a condition that can mimic other emergencies.

If sudden severe symptoms occur, call 995 in Singapore for emergency assessment. Do not wait for a clinic appointment or try to decide from an online checklist whether the pain is definitely a dissection. Other causes of sudden severe pain may also require urgent care.

How do doctors diagnose aortic dissection?

The emergency team considers the symptoms, examination and medical history, including known aortic disease or relevant inherited conditions. High blood pressure is an important risk factor, although its presence alone does not diagnose a dissection.

CT angiography is commonly used when acute aortic disease is suspected because it can show the aorta and its branches quickly and in detail. In particular circumstances, other imaging such as transoesophageal echocardiography or MRI may be appropriate.

The “think aorta” message is a prompt for timely clinical judgement and suitable imaging. It does not mean that every episode of back pain needs a CT scan. The choice of test depends on the level of concern and the patient’s condition.

How is an aortic dissection treated?

Treatment depends on which part of the aorta is involved and whether complications are present. A dissection involving the ascending aorta, called type A, generally requires urgent surgical assessment and repair.

A type B dissection does not involve the ascending aorta. If it is uncomplicated, treatment often begins with careful medical management, including control of blood pressure and heart rate, followed by surveillance. Complications such as threatened organ blood flow or rupture may require intervention.

For selected patients, an endovascular stent graft can be placed through the blood vessels to cover the entry tear and redirect blood flow. Other situations require open surgery. The safest approach is determined by the anatomy, urgency and specialist assessment.

Separate guides explain TEVAR for selected type B dissection and open, hybrid and endovascular aortic arch repair.

Why is follow-up important after treatment?

Recovery from the immediate event is one stage of care. The remaining aorta may still require imaging, blood-pressure management and specialist review. Follow-up helps the team identify changes and plan further treatment when necessary.

For non-emergency questions about known aortic disease or follow-up, you can explore my aortic awareness information and contact Andrew Choong Vascular Surgery. A family history of aortic disease may also warrant a discussion about appropriate assessment.

Current clinic location: Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Acute warning symptoms belong in an emergency service, where assessment and treatment can begin immediately.