Highlights from the Asian Society for Vascular Surgery 2025

The Asian Society for Vascular Surgery (ASVS) 2025 congress brought vascular specialists together in Singapore from 28 to 31 August 2025 at the Grand Copthorne Waterfront. Looking back at the meeting, two themes stand out for me: the continuing importance of open aortic surgery and the careful evaluation of artificial intelligence in vascular care.

I had the privilege of contributing as a member of the local organising committee and presenting two talks: Retroperitoneal Approach to the Aorta: Back to the Future and AI in Vascular Surgery: Rise of the Machine. They explored different aspects of the same responsibility: choosing care that is appropriate for the person in front of us.

As a vascular and endovascular surgeon in Singapore, I value meetings that connect surgical experience, research and practical discussion. This retrospective shares the ideas behind those talks and explains their relevance for patients.

Why does open aortic surgery still matter?

The aorta is the body’s main artery. An aortic aneurysm is an abnormal enlargement of part of that artery. Depending on its size, growth, location and symptoms, an aneurysm may need surveillance or repair. My guide to aortic disease and aneurysm treatment explains the conditions and the main treatment options.

Endovascular aneurysm repair, or EVAR, uses a stent graft placed through the blood vessels to treat a suitable aneurysm from within. It has changed aortic practice, but open surgery remains important when anatomy, previous treatment or other clinical factors make it the more appropriate option.

What is the retroperitoneal approach to the aorta?

The retroperitoneal approach reaches the aorta through the space behind the lining of the abdominal cavity. It is an established route for selected open aortic operations. My talk revisited why this technique remains relevant alongside modern endovascular treatment.

The route of access matters because the surgeon needs a clear view of the diseased artery and its important branches. Previous abdominal operations, the extent of aortic disease and the planned repair can all influence the choice. A retroperitoneal operation is still major surgery, with risks that need individual discussion.

Is open surgery better than EVAR?

Neither is the best option for everyone. The decision depends on the aneurysm’s anatomy, overall health, procedural risks, durability and follow-up requirements. Some patients do not need an operation at all and are better served by monitoring and medical care.

For a patient-friendly explanation of the stent-graft approach, read how EVAR treats an aortic aneurysm. The useful question is which approach offers a suitable balance of benefits and risks for you.

What could artificial intelligence contribute to vascular surgery?

My second talk considered how artificial intelligence, or AI, might support vascular practice. Research includes analysing medical images, identifying patterns in clinical data and estimating risks. These applications raise useful questions about how clinicians interpret information and plan care.

Why does validation matter?

A model that performs well in a research dataset may not work equally well in a different hospital or patient population. Before relying on a tool, clinicians need evidence about its accuracy, limitations and usefulness in practice. Data quality, privacy and ongoing oversight matter as much as an impressive demonstration.

Will AI replace a vascular surgeon?

AI tools should support clinical judgement, with human oversight. They cannot by themselves provide the full conversation about symptoms, examination findings, scan results, personal priorities and treatment choices. A prediction also needs to be explained in a way that helps a patient make an informed decision.

For patients, the practical question is whether a particular tool has been shown to help in their situation. Discussing emerging technology at a conference does not mean that every application is established or routinely used in the clinic.

Friends, colleagues and shared learning

One of the pleasures of ASVS 2025 was reconnecting with friends and colleagues from across the world. Sharing experience gives us opportunities to question assumptions, discuss difficult decisions and learn from approaches used in different settings.

The photographs below capture some of those connections. They are a reminder that professional education also happens through conversation and collaboration.

What do these discussions mean for patients?

The message I took from these two talks is that established surgical skills and new technology both need thoughtful application. The aim is to understand the condition, explain the available options and agree a plan suited to the individual.

If you are discussing an aortic aneurysm with your surgeon, useful questions include:

• What do my scans show, and how has the aneurysm changed?

• Is surveillance appropriate, or is there a reason to consider repair now?

• What are the benefits and risks of the options suitable for my anatomy?

• What follow-up would I need after treatment?

I am grateful for the opportunity to share my work at ASVS 2025 and learn from colleagues. Continuing education remains part of how I approach vascular care, alongside careful assessment and clear communication with patients.

Sharing perspectives with fellow panellists at ASVS 2025 in Singapore.

Vascular assessment in Singapore

For questions about known aortic disease or treatment options, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Previous scan reports and a medication list can help make the consultation more useful.

You can also explore my aortic awareness information and educational channels and updates.

This is a retrospective of a professional meeting and provides general education. Decisions about investigation or treatment require an individual clinical assessment.

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.

World Patient Safety Day: Safer Vascular Care Starts Early

Safe vascular care begins before an operation or procedure is discussed. It starts with understanding the symptoms, examining the circulation, reviewing the right scans and asking what we are trying to prevent or treat.

For World Patient Safety Day, my message is that careful decisions matter at every stage. Aneurysms, blocked arteries, diabetic foot problems, deep vein thrombosis and carotid disease can have serious consequences, but their management needs to fit the individual patient.

Why does safety start with the assessment?

Similar symptoms can have different causes. Leg pain may relate to arterial circulation, veins, nerves or joints. Swelling may have several explanations. A scan abnormality also needs to be interpreted in context: we need to understand whether it explains the symptoms and whether it poses a risk that treatment can meaningfully reduce.

I begin by listening to what has changed and how it affects daily life. Examination, including pulse checks when appropriate, helps guide further investigation. Reviewing existing scans and previous treatment information can be as important as deciding whether another test is needed.

What problem is treatment meant to solve?

This is a practical question to ask in any vascular consultation. The goal might be to improve walking, support a wound's healing, reduce aneurysm-related risk or treat a blood clot. Different goals lead to different choices and different measures of success.

For example, assessment of peripheral arterial disease considers both walking symptoms and whether blood supply is sufficient for the foot. Assessment of aortic disease considers the part of the aorta affected, the scan findings, symptoms and overall health. A procedure is useful when its expected benefits justify its risks for that particular situation.

Can surveillance be an active treatment plan?

Yes. For some patients, monitoring and risk-factor management are the appropriate next steps. Surveillance means a planned review of the condition, with agreed follow-up and an explanation of what changes should trigger earlier reassessment. It does not mean ignoring a known problem.

Managing blood pressure, cholesterol, diabetes and smoking can be central to vascular care. The details depend on the condition and prescribed treatment. A good plan makes clear what needs monitoring, who is responsible for follow-up and what the patient should do if symptoms change.

Is the newest or least invasive procedure always safest?

No. Angioplasty, stents, endovascular repair, open surgery and clot-removal procedures each have roles. Their suitability depends on anatomy, disease severity, urgency, other medical conditions and the durability needed. A smaller incision alone cannot answer those questions.

Sometimes an endovascular approach is appropriate. Sometimes open surgery or a combination of techniques is a better fit. In other cases, an intervention would add risk without sufficient benefit. My aim is to explain the available options in relation to your condition rather than let a particular technology determine the plan.

How can patients take part in safer decisions?

Bring an up-to-date medication list, relevant scans and information about previous procedures. Tell the clinical team about allergies, kidney disease, previous reactions to contrast and concerns about recovery. These details help planning.

Questions worth asking include:

• What is the diagnosis, and how certain are we?

• What benefit would this treatment offer me?

• What are the important risks and alternatives?

• What happens if we monitor the condition first?

• What follow-up and warning signs should I understand?

You should have an opportunity to discuss what matters to you, including mobility, independence and time away from work or family responsibilities. Clear explanations support a decision you understand.

When should assessment happen urgently?

Some changes cannot wait for scheduled review. Sudden severe chest or back pain, new stroke symptoms, collapse, serious breathlessness or a suddenly cold, painful or weak limb need emergency care. A deteriorating foot wound or new painful leg swelling also needs prompt assessment. If emergency ambulance help is needed in Singapore, call 995.

Where can I discuss my vascular care plan?

For a non-emergency assessment, scan review or second opinion, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Careful assessment and a clear discussion of options are the starting point for choosing treatment at the right time.

Keyhole Vascular Treatment | Endovascular Surgery

Endovascular treatment means treating a blood vessel from the inside. Through a small access point in an artery or vein, I can guide specialist instruments to the area that needs treatment. This is often described as “keyhole” or minimally invasive vascular surgery.

In this video, I introduce some of the tools used in modern vascular practice. The same small access point can support very different procedures, so it helps to understand the problem each tool is designed to address.

How do the instruments reach the blood vessel?

A small tube called a sheath provides access into the artery or vein. Guidewires and catheters can then be passed through it, with imaging used to guide their position. Depending on the condition, the treatment may involve balloons, stents, covered stent-grafts or devices designed to remove clot.

The access site and instruments are chosen for the anatomy and the intended procedure. The visible skin opening is only one part of the treatment: detailed planning and precise work take place inside the circulation.

How can a stent-graft treat an aneurysm?

An aneurysm is an abnormal enlargement of an artery. For a suitable aortic aneurysm, an endovascular stent-graft can create a channel for blood flow inside the diseased vessel. In my video, I describe this as a pipe within a pipe.

The graft is designed to seal against appropriate portions of the artery and exclude the aneurysm from the main blood flow. Whether this is possible depends on the shape, size and location of the aneurysm and the arteries used for access. You can read more in my aortic disease and aneurysm treatment guide.

Endovascular aneurysm repair also requires follow-up. Scans help check the graft and aneurysm over time, because treatment does not remove the need to monitor the remaining aorta.

What do balloons and stents do for narrowed arteries?

When an artery is narrowed or blocked, angioplasty uses a balloon to widen an appropriate segment. A stent may be used to support the treated vessel. The aim is to improve blood flow where the narrowing is causing a clinically important problem.

These techniques may be considered for selected patients with peripheral arterial disease, including some people with substantial walking limitation or threatened wound healing. Medication, risk-factor management and suitable exercise remain important; a scan showing narrowing does not automatically mean a stent is needed.

Can endovascular tools remove blood clots?

Some specialist devices can break up or remove clot through a catheter. Aspiration devices use suction; other mechanical systems work differently. The tool depends on what is blocking the vessel, where it is located and the patient's condition.

In selected cases of deep vein thrombosis or pulmonary embolism, a procedure to remove clot may be appropriate. It is not the standard answer for every blood clot. Anticoagulation and other treatments must be considered alongside the potential benefits and risks of an intervention.

Likewise, an artery blocked by longstanding plaque is not the same as a vessel containing a recent clot. Descriptions such as “drill” or “vacuum” are useful visual analogies, but they do not mean every blockage can or should be treated in the same way.

Does “keyhole” mean the procedure is minor?

No. A small access point can be used to treat a major vascular condition. Endovascular procedures can offer advantages for suitable patients, but they still carry risks and may require further treatment or ongoing surveillance. Some patients are better served by open surgery, a combined approach or medical management.

Before treatment, I consider the scans, overall health, clinical urgency and the outcome we are trying to achieve. I also discuss recovery, follow-up and alternatives so that the plan is understandable, rather than simply choosing the newest device.

Where can I discuss vascular treatment in Singapore?

For an individual opinion about vascular or endovascular treatment, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Bring relevant scan reports and previous treatment information if available.

The tools are valuable when they solve the right problem. My role is to connect those options to your anatomy, symptoms and goals, and explain which approach is appropriate for you.

Poor Leg Circulation?

If you have been told that you may have poor circulation in your legs, the first step is to understand the blood-flow problem. The important questions are how much circulation is affected, where the disease is, and whether the foot or leg is at risk.

In this video, I explain what I look for during a vascular assessment for suspected peripheral arterial disease, or PAD. A treatment decision follows that assessment; it is not determined by the phrase “poor circulation” alone.

What is peripheral arterial disease?

Peripheral arterial disease occurs when arteries supplying the legs become narrowed or blocked, commonly because plaque has built up in their walls. Reduced blood flow may limit the oxygen available to the muscles during walking or, in more severe disease, affect the tissues even at rest.

PAD is an arterial problem. Other conditions, including venous disease, nerve problems and joint disorders, can also cause leg symptoms. Establishing the cause matters because their treatments are different.

Which symptoms can suggest poor arterial circulation?

A familiar pattern is discomfort or cramping in the calf, thigh or buttock that starts with walking and eases when you stop. This is called intermittent claudication. Some people also notice coldness, numbness or wounds that are slow to heal.

Symptoms that deserve particular attention include:

• Walking pain that repeatedly limits the same everyday activities.

• Foot or toe pain at rest, especially when persistent or occurring at night.

• A wound or ulcer that is not healing.

• Dark or black tissue, or a new change in foot colour or temperature.

These features need clinical assessment; none should be diagnosed from an online description alone. Diabetes can alter sensation, so a threatened foot may not always be as painful as expected.

What will I ask during the consultation?

The history helps connect the symptoms to what the leg is doing. How far can you walk? Where does the pain occur? Does it settle with rest, and does it return when you start again? Has the walking distance changed? Are there wounds, night pain or symptoms in the other leg?

I also ask about diabetes, kidney disease, smoking, heart disease and previous arterial treatment. Earlier angioplasty, stents or bypass operations can affect both the investigation and the options available. Bring your medication list and previous scan or operation information if you have it.

How are the legs and blood flow examined?

I examine the legs and feet, checking pulses, skin colour, temperature, wounds and signs of infection. The aim is to establish the likely circulation problem and identify whether the foot needs urgent attention.

Tests may include an ankle–brachial pressure measurement, which compares blood pressure at the ankle and arm, and duplex ultrasound to assess blood flow. Diabetes or kidney disease can make ankle-pressure results misleadingly high, so a normal result may not exclude PAD; toe-pressure testing or further assessment may be needed. Other tests or CT angiography may be appropriate when more detailed information is needed, particularly when planning a procedure. The choice depends on the clinical question rather than ordering every available scan.

Does PAD always need angioplasty or surgery?

No. Many patients need a plan built around prescribed medication, management of cardiovascular risk factors and an appropriate structured exercise programme. Stopping smoking and controlling diabetes, blood pressure and cholesterol are important parts of care.

For selected patients, angioplasty, stenting or bypass surgery may improve circulation. A procedure may be considered for symptoms that remain substantially limiting despite suitable treatment, or when blood supply threatens wound healing or limb survival. I weigh the artery pattern, wound risk, expected benefit and overall health together.

The goal is more than opening a narrowed artery on a scan. It is to improve function, support healing when needed and reduce the risk of complications.

When is poor circulation an emergency?

A suddenly painful, cold, pale, numb or weak limb needs immediate emergency assessment. Seek urgent care rather than waiting for a routine appointment. A non-healing wound, black toe or persistent rest pain also needs prompt assessment; do not try to exercise through a threatened or infected foot.

Where can I arrange a circulation assessment in Singapore?

For non-emergency symptoms or review of known PAD, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. I will assess your symptoms, examination and blood-flow findings together to discuss a treatment plan suited to you.

Varicose veins: scan first, treatment second

The most suitable treatment for varicose veins cannot be chosen simply by looking at the veins on the surface. A proper assessment, including vascular ultrasound when planning treatment, helps identify the underlying problem and guides what to do next.

In this video, I explain why I start with the question of where abnormal blood flow is coming from. Two people may have very similar-looking veins but need different treatment plans.

Why are visible varicose veins only part of the picture?

Veins return blood towards the heart. In the legs, one-way valves help prevent blood from falling backwards between contractions of the leg muscles. When those valves do not work properly, blood can flow in the wrong direction. This is called venous reflux.

The bulging veins you can see may be the result of reflux elsewhere in the venous system. Treating a visible vein without understanding that pattern may leave an important source of the problem untreated. My guide to varicose veins and venous disease explains how reflux can contribute to aching, heaviness, swelling and skin changes.

What does a vascular ultrasound scan show?

A duplex ultrasound examines both the structure of the veins and the way blood moves through them. It helps map which veins are involved and where reflux occurs. The findings are interpreted alongside symptoms, examination and previous treatment rather than in isolation.

This mapping can distinguish problems in the main superficial veins, their branches and the deeper venous system. These distinctions matter: a visible cluster of veins does not automatically tell us which vessel should be treated or whether it is the main cause of the symptoms.

The scan therefore provides information that a photograph cannot. It gives the treatment discussion a basis beyond appearance alone.

Why might two similar-looking legs need different treatments?

One person may have reflux in a superficial vein that is suitable for an endovenous procedure. Another may have a different reflux pattern, previous vein treatment or additional venous problems that change the plan. Sometimes the visible veins are not the main issue.

I also consider what is troubling the patient. Discomfort during work, swelling at the end of the day, troublesome itching and skin changes raise different questions from appearance alone. Understanding the effect on daily life helps us decide what improvement treatment should aim to achieve.

Which treatments might follow the scan?

Depending on the findings, options can include endovenous laser treatment, radiofrequency ablation, medical glue or ultrasound-guided foam sclerotherapy. These approaches work in different ways to close an appropriate abnormal superficial vein so that blood can return through other functioning veins.

Some patients need a different procedure or a combination of treatments. Others may benefit from conservative management and review. No single method is right for every leg, and finding reflux does not mean everyone must immediately undergo an intervention.

The discussion should cover the expected benefit, possible complications, alternatives and follow-up. It should also explain whether treating the main source of reflux and treating visible branches would happen together or in stages.

What should I ask before agreeing to varicose vein treatment?

Useful questions include:

• Where is the reflux coming from, and does it explain my symptoms?

• Which vein would be treated, and why?

• What alternatives are suitable for my scan findings?

• What recovery, follow-up and possibility of further treatment should I expect?

A clear plan connects the ultrasound findings to your symptoms and goals. The name of a device or a treatment alone cannot provide that explanation.

When should I arrange an assessment in Singapore?

Consider vascular review if varicose veins cause persistent aching, heaviness, swelling, itching or skin changes, or if you are considering treatment. An ulcer, bleeding vein or sudden painful swelling needs prompt medical attention; sudden swelling should not simply be assumed to be ordinary varicose veins.

For an individual assessment, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. I will relate your symptoms and scan findings to the options available. Scan first, treatment second: the aim is a plan that fits the actual problem.

What Is Linked to 11 Million Deaths a Year? Sepsis, Foot Wounds and Poor Circulation

Sepsis happens when the body's response to an infection begins to damage its own tissues and organs. It can become life-threatening quickly. In this World Sepsis Day video, I explain why a worsening foot wound deserves particular attention when someone has diabetes or poor circulation.

As a vascular surgeon in Singapore, I look at two linked questions: is the wound infected, and is enough blood reaching the foot for it to heal? Both matter when deciding how urgently someone needs care.

What does the figure of 11 million deaths mean?

The figure in my video reflects a major global estimate: approximately 48.9 million sepsis cases and 11 million sepsis-related deaths worldwide in 2017, reported in research published in 2020. These figures describe the scale of the problem; they are not a new count for 2026 or a prediction of what will happen to an individual patient.

Sepsis can arise from many infections. A foot wound is one possible source, particularly when infection spreads or a person's ability to fight infection and heal is impaired.

Why can a small foot wound become serious?

A small break in the skin can allow infection to develop. Diabetes, kidney disease and poor arterial circulation can complicate the situation. A history of smoking also matters because it increases the risk of vascular disease. The appearance of the wound alone does not tell the whole story.

When peripheral arterial disease reduces blood flow, the tissues may not receive enough oxygen and nutrients to support healing. Antibiotics and appropriate dressings may be necessary, but they do not automatically correct a circulation problem. Infection control and assessment of blood supply need to be considered together.

Can a diabetic foot infection be serious without much pain?

Yes. Diabetes can damage the nerves that normally warn us about an injury. A wound or infection may therefore hurt less than expected. Little pain is not reliable reassurance, especially if the foot looks different, the wound is worsening or the person feels unwell.

This is why I encourage patients and families to notice changes rather than wait for severe pain. A new wound, spreading redness, increasing swelling, discharge or a change in skin colour needs attention, even when walking remains possible.

Which warning signs need urgent help?

A foot wound needs prompt medical assessment if it develops pus, worsening redness or swelling, severe pain, black tissue or a rapid change in appearance. In someone with diabetes or known poor circulation, do not wait for a wound to become large before seeking help.

Possible sepsis is an emergency. Warning signs may include:

• New confusion, unusual drowsiness or sudden deterioration.

• Severe shivering, fever, or feeling markedly unwell.

• Breathlessness or unusually rapid breathing.

• Passing very little urine.

• Mottled, pale, blue or otherwise discoloured skin.

Not everyone has every sign. If someone with an infection becomes seriously unwell, seek emergency care immediately; in Singapore, call 995 when emergency ambulance help is needed. Do not wait for a routine clinic appointment.

How does a vascular assessment help?

I assess the wound alongside the person's symptoms, medical history, foot temperature, skin changes and pulses. When indicated, blood-flow tests or vascular ultrasound help establish whether narrowed or blocked arteries are contributing to poor healing. Further imaging depends on the findings and the treatment being considered.

The plan may involve infection treatment, wound care, pressure relief and management of diabetes and other risk factors. Some patients also need a procedure to improve circulation. The right sequence depends on the severity of infection, the blood supply and the person's overall health.

Where can I discuss a foot wound or circulation concern in Singapore?

For a non-emergency vascular assessment, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. I can assess whether poor circulation is affecting healing and discuss an appropriate treatment plan.

This article accompanies my video for general patient education. A worsening wound needs an individual assessment, and suspected sepsis requires immediate emergency care.

Can Walking Improve Your Circulation???

Walking can support both arterial and venous circulation, but it helps them in different ways. For people with assessed, stable claudication, structured walking can improve walking ability. For venous symptoms, each step activates the calf muscles and helps move blood back towards the heart.

In this video, I explain these two benefits and the warning signs that should never simply be “walked off”. The right exercise plan depends on the cause of your symptoms, your overall health and whether it is safe for you to walk.

How can walking help arterial disease?

Claudication is cramping, aching or tightness in the calf, thigh or buttock that develops with activity and improves with rest. When it is caused by peripheral arterial disease (PAD), narrowed arteries cannot meet the muscles’ increased demand for oxygen during walking.

Regular training can improve fitness and how effectively the leg muscles use oxygen, helping some people walk further before symptoms limit them. This does not mean that a blocked artery has simply opened or that everyone will improve at the same rate.

Exercise is one part of PAD care. Smoking cessation, management of cholesterol, blood pressure and diabetes, and prescribed medicines also matter because PAD is linked to wider cardiovascular risk.

What is the walk–rest–repeat approach?

For suitable people with stable claudication, a structured programme often uses intervals of walking and rest. In the video, I describe this pattern:

1. Walk until the familiar discomfort becomes moderate. Use the level of effort agreed with your clinician.

2. Stop and rest until it settles. Allow the discomfort to ease before starting again.

3. Resume walking and repeat. Build consistency within an individual programme rather than force a particular distance.

A supervised or clinician-supported programme can help set a suitable pace and monitor progress. This approach is for an assessed condition; unexplained new pain should first be investigated. Severe pain, a sudden change or symptoms at rest should not be treated as a training target.

How does walking help the veins?

Leg veins return blood towards the heart. When your calf muscles contract, they squeeze the veins and help propel blood upwards. One-way valves support this flow and limit backward movement.

Walking therefore activates the calf muscle pump, unlike remaining still for long periods. It can help some people with venous heaviness, aching or swelling. If there is venous reflux or varicose veins, movement may be part of symptom management, but it does not repair faulty valves.

Compression may also be appropriate for selected patients. The type and pressure should be advised according to the venous problem, arterial circulation and other health conditions.

How can you make walking a sustainable habit?

Choose a route and pace that suit your mobility and balance. Comfortable, well-fitting footwear matters, particularly if you have diabetes or reduced sensation. Check your feet for rubbing, blisters or wounds rather than relying only on pain to alert you.

In Singapore’s heat, a cooler time of day or a sheltered route may make activity more comfortable. Build the routine around your circumstances and any medical advice, including fluid restrictions if you have them.

A simple note of your walking time, symptoms and recovery can help you and your clinician see whether the pattern is improving or changing. Walking can also support glucose control, heart health and general conditioning, although it does not replace prescribed treatment.

When should you stop and seek medical help?

Seek urgent assessment for new pain at rest, a non-healing wound, blackened toes or one-sided painful swelling. Swelling with warmth or tenderness may need investigation for DVT, not a longer walk.

Sudden severe leg pain with coldness, numbness or weakness requires emergency assessment. Chest pain, sudden breathlessness or collapse also need emergency care. In Singapore, call 995 for a life-threatening emergency rather than waiting for a routine appointment.

Planning safe walking with a vascular condition

If leg symptoms are limiting your daily activity, contact Andrew Choong Vascular Surgery to discuss assessment at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Understanding the cause helps us decide how walking fits into your care.

This article provides general education and does not replace an individual medical assessment.

DVT Warning: Red, hot, swollen painful leg

A new swollen, painful or unusually warm leg, especially on one side, needs urgent medical assessment. It may be a deep vein thrombosis, or DVT: a blood clot in a vein deep inside the leg. Not everyone has every symptom, and you should not wait for a complete checklist before seeking help.

In this video, I explain why this combination matters, which situations can increase the risk of a clot and how an ultrasound scan helps investigate it. The message is straightforward: do not dismiss a sudden change as ordinary tiredness or your usual leg swelling.

What symptoms can a DVT cause?

Possible symptoms include:

• Swelling: commonly affecting one leg more than the other.

• Pain or tenderness: often in the calf or thigh, without an obvious explanation.

• Warmth: an affected area that feels hotter than usual.

• A change in skin colour: including redness or darker colouring, which may be less obvious on some skin tones.

Other conditions, such as infection, injury or inflammation, can produce similar symptoms. Some people with DVT have few or no obvious signs. This is why appearance alone cannot confirm or exclude a clot. Our DVT information page explains the condition in more detail.

Why can a clot in the leg affect the lungs?

A DVT can interfere with blood drainage from the leg. If part of the clot breaks away, it can travel through the circulation and lodge in the blood vessels of the lungs. This is called a pulmonary embolism (PE), which can be life-threatening.

Sudden breathlessness, chest pain, coughing blood, fainting or collapse require emergency assessment. These symptoms can occur even without obvious leg symptoms. In Singapore, call 995 for a life-threatening emergency. Do not wait for a clinic appointment or an online reply.

Who has a higher risk of DVT?

In the video, I highlight cancer, some blood conditions, long-haul travel, periods of immobility and major orthopaedic surgery. These situations may increase the tendency for blood to clot or reduce its movement through the leg veins.

Previous DVT, pregnancy and the period after childbirth, and some hormone treatments are also relevant. Several risks can occur together. However, DVT can happen without an obvious trigger, so the absence of a recent flight or operation is not a reason to ignore symptoms.

Long journeys by car, bus or train can also involve prolonged sitting. The concern is not unique to flying; limited movement and a person’s underlying risk both matter.

How is a suspected DVT assessed?

A clinician will ask about the symptoms, examine the leg and review your risk factors. A venous duplex ultrasound is a common first-line imaging test. It examines the deep veins and helps identify a clot and its location.

Depending on the clinical assessment, blood tests or further imaging may also be needed. If symptoms persist or change after an initial assessment, follow the advice given about reassessment. A scan result needs to be interpreted alongside the full clinical picture.

What happens if a DVT is confirmed?

Treatment commonly involves anticoagulant medicines, often called blood thinners. They help stop the clot extending and reduce the risk of further clots while the body deals with the existing clot. The medicine and duration depend on factors such as the clot’s location, cause and bleeding risk.

Some patients need additional specialist treatment. Follow-up also considers ongoing swelling or discomfort and whether there are underlying factors to address. A new suspected clot needs urgent care, rather than treatment based only on information in a video.

What can you do before a long journey?

Move your legs regularly and take opportunities to walk when safe. Keeping normally hydrated is sensible, but drinking water alone should not be regarded as protection against a travel-related clot.

If you have had a clot, recent surgery, cancer or another significant risk factor, discuss travel precautions with your clinician beforehand. Compression stockings or preventive medicines are appropriate for selected people and should be individually advised.

DVT assessment in Singapore

Seek urgent medical care for new one-sided painful swelling. For non-emergency questions about previous DVT or ongoing venous care, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

This article provides general education and does not replace an individual medical assessment.

What Is a Duplex Ultrasound? Vascular Surgeon Explains

Duplex ultrasound combines an image of a blood vessel with information about the blood flowing through it. Ultrasound provides the picture; Doppler assesses movement and flow. Together, they help us investigate problems affecting arteries and veins.

In this video, I explain why a duplex scan is frequently used for varicose veins, leg swelling, blocked arteries and possible blood clots. Understanding what the test measures can make a scan appointment less unfamiliar and help you understand the next steps in your care.

What does the ultrasound part show?

Ultrasound uses high-frequency sound waves. A probe sends these waves into the body and receives the echoes that return from tissues. The machine converts those echoes into an image.

For a vascular scan, this helps show the vessel and the structures around it. The person performing the scan can examine a particular area and take measurements relevant to the clinical question.

What does Doppler add?

Doppler uses changes in reflected sound waves to assess moving blood. It provides information about the direction and speed of flow, which can be displayed as colours or waveforms and sometimes heard as a sound.

This matters because a vessel’s appearance is only part of the story. I also need to understand whether blood is passing through effectively, whether flow is altered by narrowing, or whether it is moving backwards through a vein. Duplex brings the image and flow assessment together.

Which circulation problems can a duplex scan investigate?

• Varicose veins and venous reflux: identifying backward flow and mapping affected veins when assessing venous symptoms.

• Possible blood clots: examining the deep veins when deep vein thrombosis (DVT) is suspected.

• Narrowed or blocked arteries: assessing blood flow in people with symptoms that may relate to peripheral arterial disease.

• Treatment planning or follow-up: providing information that may guide a procedure or help assess circulation afterwards.

The scan is tailored to the reason for referral. An examination for venous reflux is not identical to an arterial scan or a scan for suspected DVT. Explaining your symptoms clearly helps ensure the assessment answers the relevant question.

What happens during the scan?

Usually, gel is applied to the skin and a handheld probe is moved over the area being examined. You may be asked to change position so the vessels can be assessed properly. The area needs to be accessible, so comfortable clothing can be helpful.

A standard external duplex scan is non-invasive and does not use ionising radiation. You may hear the machine’s blood-flow sounds during the examination. Let the sonographer know if an area is painful or if you have difficulty standing or changing position.

Preparation and appointment length depend on the vessels being examined. Follow the instructions supplied by the clinic rather than assuming every ultrasound appointment has the same requirements.

Does a scan result tell the whole story?

No single investigation replaces a clinical assessment. I interpret the findings alongside your symptoms, examination and medical history. Sometimes duplex provides the information needed; sometimes further tests or another form of imaging are appropriate.

Useful questions to ask include: What was the scan looking for? What did it show? Does the finding explain my symptoms? What should happen next? The aim is to connect the result to a clear care plan, rather than leave you with an unfamiliar technical term.

Duplex ultrasound assessment in Singapore

As I explain in the video, our practice has its own vascular laboratory and a dedicated vascular sonographer who focuses on vascular scans. For advice about an assessment, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

New one-sided painful leg swelling needs urgent assessment; do not wait for a routine scan appointment. Sudden breathlessness, chest pain or collapse requires emergency care. Call 995 in Singapore for a life-threatening emergency.

This article provides general education and does not replace an individual medical assessment.

EVAR for Aortic Aneurysms: A Pipe Within a Pipe

EVAR treats a suitable aortic aneurysm from inside the blood vessel using a stent graft. A useful way to picture it is a pipe within a pipe: blood flows through a new lining designed to reduce pressure on the weakened aneurysm wall.

In this video, I introduce endovascular aortic repair and explain why it has become an important option for some patients. It is less invasive than open repair, but the right choice depends on the aneurysm, your overall health and the need for long-term follow-up.

What is an aortic aneurysm?

The aorta is the body’s main artery. An aneurysm is an abnormal enlargement of part of that artery, associated with weakening of its wall. Many aneurysms cause no symptoms and are discovered during a scan performed for another reason or through screening.

The concern is rupture, which can cause life-threatening internal bleeding. However, finding an aneurysm does not automatically mean an operation is needed. Smaller aneurysms may be monitored, with decisions guided by their size, growth, symptoms and the balance of treatment risks. Read more about aortic aneurysms and aortic disease.

How does EVAR work?

During EVAR, a stent graft is introduced through the arteries in the groin and positioned inside the aorta using imaging guidance. Access may be through small punctures or small incisions, depending on the vessels and the planned procedure.

The graft has a supporting framework and a fabric covering. It forms a channel through which blood can flow, with seals above and below the aneurysm in suitable anatomy. The aneurysm remains outside the graft, so the operation does not simply remove the enlarged artery.

The aim is to exclude the aneurysm from the main blood flow and reduce its risk of rupture. Whether this can be achieved safely must be assessed before treatment.

Who may be suitable for EVAR?

A CT scan helps the vascular team evaluate the aneurysm and plan a repair. Important considerations include:

• The aneurysm’s location and shape: including its relationship to important branch arteries.

• Suitable sealing areas: where the graft can fit securely.

• Access through the groin arteries: their size, narrowing and tortuosity can matter.

• Your overall health: including kidney function, fitness and other medical conditions.

• Long-term care: including the ability to attend follow-up scans.

Some aneurysms need a more complex endovascular approach or open surgery. For others, continued surveillance is appropriate. These decisions form part of individual treatment planning.

How does EVAR compare with open repair?

For suitable patients, EVAR can offer a less demanding early recovery and lower short-term operative risk than open repair. Those early benefits do not mean it is the best option for everyone or that the aneurysm requires no further attention.

Open repair remains important. The discussion includes the expected benefits, procedural risks, durability and likelihood of needing further treatment. I would explain why an option fits your particular anatomy and circumstances rather than choose solely by the size of the incision.

Why are follow-up scans important?

After EVAR, scans check the graft’s position and whether the aneurysm remains effectively excluded. One issue they look for is an endoleak, meaning blood still reaches the aneurysm sac outside the graft. Some findings require monitoring; others may need another procedure.

Follow-up is therefore part of the treatment, even when you feel well. The schedule and type of scan depend on the repair and subsequent findings.

Should you discuss aneurysm screening?

In the video, I encourage people with a family history, and men over 55 particularly with smoking or high blood pressure, to discuss their risk. This is an invitation to an individual assessment, not a universal screening rule for everyone over 55. Screening recommendations vary by age, sex, smoking history and family history.

Ultrasound can assess the abdominal aorta when screening is appropriate. Sudden severe abdominal or back pain, especially with collapse, needs emergency care instead of a screening appointment. In Singapore, call 995 for a life-threatening emergency.

Aortic aneurysm assessment in Singapore

To discuss a known aneurysm or your screening risk, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

This article provides general education and does not replace an individual medical assessment.

Why Do Some Foot and Leg Wounds Not Heal?

A foot or leg wound that is not healing may need more than a change of dressing. Wound healing depends on several things working together, including an adequate blood supply, controlled swelling, protection from pressure and appropriate management of infection and underlying health conditions.

In this video, I focus on two questions from a vascular perspective: is enough blood reaching the wound through the arteries, and are the veins draining effectively? These questions can help explain why a wound remains open despite regular care.

When is a wound considered chronic?

In the video, I describe a wound that persists beyond about four weeks as chronic. Definitions vary, and the important point is that a wound which is not progressing needs its underlying cause reviewed.

Four weeks is not a waiting period before seeking help. A new foot wound in someone with diabetes, a worsening wound or signs of infection deserves earlier assessment. Reduced sensation can make a significant wound surprisingly painless.

How can blocked arteries delay healing?

Arteries bring blood carrying oxygen and nutrients to the tissues. If they are narrowed or blocked, the wound may not receive enough blood to repair itself effectively. This is one reason peripheral arterial disease (PAD) matters in foot and leg wound care.

Some people also notice pain when walking, pain at rest or a foot that feels unusually cold. Others have fewer obvious symptoms, particularly if diabetes has affected their nerves. The wound’s appearance alone cannot establish whether the blood supply is adequate.

How can vein problems affect a wound?

Veins return blood from the legs towards the heart. When their one-way valves do not work properly, blood can flow backwards, a problem called venous reflux. Raised venous pressure and swelling can damage the surrounding skin and interfere with healing.

This is a different mechanism from arterial blockage. Someone with venous disease or varicose veins may also have ankle swelling, aching, brownish skin changes or a recurrent ulcer. Arterial and venous problems can occur together, so treatment should follow an assessment rather than an assumption.

What else can prevent a wound from healing?

Circulation is only part of the picture. Factors that may need attention include:

• Diabetes: including glucose control, nerve damage and infection risk.

• Pressure or repeated injury: for example, footwear rubbing the same area.

• Smoking and nutrition: both can affect the body’s ability to repair tissue.

• Medicines and other illnesses: these may influence healing and should be reviewed.

• Infection: which can worsen a wound and become more serious when blood supply is poor.

What does a vascular wound assessment involve?

I would ask how the wound started, how long it has been present and what care it has received. Examination includes the wound, surrounding skin, swelling and foot pulses. Your medical history and medicines help guide further investigation.

Tests may include ankle or toe pressure measurements and duplex ultrasound to assess arterial flow or venous reflux. Further imaging is selected according to the findings. Not every wound requires every test or a procedure.

A treatment plan may combine dressings, pressure relief, management of infection and diabetes, and treatment of a circulation problem where appropriate. Compression can help selected venous ulcers, but its suitability depends on the arterial blood supply. Avoid starting tight bandaging yourself.

Which changes need urgent attention?

Seek urgent medical help for spreading redness, increasing warmth or swelling, pus, worsening pain, fever or black tissue. A suddenly cold, painful, numb or weak foot needs emergency assessment. Do not wait for a routine clinic appointment if the problem is rapidly worsening; call 995 in Singapore for a life-threatening emergency.

Assessment for a non-healing wound in Singapore

For a wound that is slow to heal, contact Andrew Choong Vascular Surgery to discuss assessment at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Understanding the cause helps guide care beyond the dressing itself.

This article provides general education and does not replace an individual medical assessment.

When Is Leg Swelling Not Just Water Retention? 2 of 2

Leg swelling that builds towards evening may be related to venous reflux, but new swelling in one leg needs prompt attention. A red, hot, painful calf can occur with deep vein thrombosis, and a clot does not always cause every one of those signs. The safest next step depends on the pattern and timing of symptoms.

This is the second part of the series. Part one explains the different causes of leg swelling.

What can the timing of swelling tell us?

With venous reflux, leaking valves make it harder for blood to return efficiently from the legs. Gravity and long periods with little movement can increase pressure in the veins. Some people notice more swelling after standing, sitting or travelling, and less after resting with their legs elevated.

That pattern can support a discussion about venous disease, but it cannot confirm the cause. In particular, swelling after a long flight should not automatically be dismissed as familiar reflux. A new one-sided change deserves assessment even if you have had varicose veins for years.

Does improvement with compression prove that the veins are responsible?

No. Feeling better in compression stockings can be useful information for your clinician, but it is not a diagnostic test. It does not rule out a blood clot or another explanation for swelling.

Tell your doctor what you have tried and how symptoms responded. If compression is being considered, the appropriate type and fit should be assessed, including whether arterial circulation or other health conditions make it unsuitable. New symptoms should be evaluated rather than managed simply by choosing tighter stockings.

When should one-sided leg swelling be checked?

New unexplained swelling affecting one leg should be checked promptly, especially if accompanied by calf pain, warmth, redness or a change in skin colour. These findings can occur with deep vein thrombosis, often called DVT, but can also have other causes.

A DVT is a clot in a deep vein. The classic description of a red, hot, swollen calf is a useful warning, not a checklist that must be complete. The absence of dramatic redness or severe pain does not safely exclude a clot. A clinician needs to assess the symptoms and relevant risk factors.

Which symptoms mean I should call for emergency help?

Call 995 in Singapore for sudden breathlessness, chest pain, coughing up blood or collapse, particularly when there is also leg pain or swelling. These can be signs of a pulmonary embolism, where a clot has travelled to the lungs, or another serious emergency.

Do not wait for a routine vein appointment if these symptoms occur. The priority is urgent hospital assessment. Leg swelling alone and leg swelling with breathing symptoms require different levels of urgency.

How does a duplex ultrasound help?

A duplex ultrasound provides information about the veins and the blood moving through them. For suspected venous reflux, the examination can assess valve function and identify the veins involved. This helps link the symptoms to an anatomical problem and supports treatment planning.

When a clot is suspected, the assessment follows an urgent diagnostic pathway. The clinician considers the history and examination and may arrange ultrasound and blood tests as appropriate. A scan requested for chronic reflux should not be assumed to replace a timely assessment for new DVT symptoms.

What should I tell the clinician?

Explain exactly when the swelling began, whether one or both legs are affected and how it differs from your usual pattern. Mention recent surgery, a hospital stay, reduced mobility, travel, cancer treatment or a previous clot. Include medicines, including hormone treatments, in your medication list.

If the swelling has been recurring over weeks or months, describe whether it improves overnight and whether there are visible veins or skin changes. This helps distinguish the questions that need to be answered rather than treating all swelling as the same condition.

What happens after the cause is identified?

Care depends on the diagnosis. Confirmed venous reflux, DVT and non-vascular causes of swelling need different approaches. An ultrasound result may lead to advice, further investigation or a discussion of suitable treatment; it does not mean everyone needs a vein procedure. Read more about varicose veins and venous conditions.

Where can I arrange a non-emergency assessment?

For persistent or recurring symptoms, contact Dr Andrew Choong’s clinic at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Bring previous imaging and your medication list. For new one-sided swelling, seek prompt medical assessment; for chest or breathing symptoms, use emergency services.

This article provides general education and does not replace an individual medical assessment.

When Is Leg Swelling Not Just Water Retention? 1 of 2

Leg swelling is often described as “water retention”, but that phrase does not explain why it is happening. Fluid can accumulate in the legs for several different reasons, including problems affecting the whole body, an injury or difficulty returning blood through the veins. Identifying the cause is the first step towards an appropriate plan.

What does “water retention” actually mean?

Swelling caused by fluid collecting in the tissues is called oedema. It describes a physical finding rather than a complete diagnosis. Two people with similarly swollen ankles may have quite different underlying problems and need different investigations.

The useful next questions are when the swelling began, whether one or both legs are affected, and what else has changed. A label alone cannot answer those questions or establish whether the situation is routine or urgent.

Can a problem elsewhere in the body cause swollen legs?

Yes. Some causes are systemic, meaning they affect the body more broadly. Heart problems can increase pressure in the circulation and contribute to swelling. Kidney or liver conditions and disturbances in fluid or protein balance can also be relevant.

Certain medicines may contribute to ankle swelling as well. This is one reason a medication list is useful at an appointment. Do not stop prescribed medicines on your own: a clinician needs to consider the timing of symptoms, the reason for treatment and possible alternatives.

Swelling in both legs may prompt questions about general health, but it does not automatically mean a heart or kidney disorder. The distribution is one clue among several, rather than a diagnosis by itself.

What local problems can make a leg swell?

A local cause affects a particular area. An injury, inflammation around a joint or an infection can produce swelling. The history may include a twist, fall, painful joint, wound or a change in the skin, but sometimes the explanation is less obvious.

One leg becoming larger than the other deserves attention, especially when the change is new. A clinician will consider vascular and non-vascular possibilities. An assessment should not start with the assumption that all swelling is due to veins.

How does venous reflux contribute to swelling?

Leg veins return blood towards the heart. Their valves help keep flow moving in the intended direction. When valves do not work effectively, blood can flow backwards, a problem called venous reflux. The resulting pressure can contribute to fluid accumulating in the tissues.

This explains why a vein problem can create more than visible varicose veins. Heaviness, aching and swelling may be part of the same circulation issue. Read more about varicose veins and venous disease.

However, finding visible veins does not prove they explain every symptom. Vein disease can coexist with a joint problem, medication-related swelling or another medical condition. The assessment needs to consider the whole picture.

What information helps identify the cause?

Before a non-emergency appointment, note whether the swelling appeared suddenly or gradually, whether it changes over the day, and whether both legs are affected equally. Describe any pain, skin changes, breathlessness or recent illness.

Also mention recent travel, surgery, reduced mobility and any previous blood clot. Bring medication details and previous test results. These observations help the clinician decide whether a venous ultrasound, other investigations or a different specialist assessment is needed. They should not delay urgent care when warning signs are present.

When should swelling be checked urgently?

Seek prompt medical assessment for new unexplained swelling in one leg, especially if it is painful, red or warm. A deep vein thrombosis is one possible cause, although other conditions can look similar. Sudden breathlessness, chest pain or collapse requires emergency help: call 995 in Singapore.

Persistent or worsening swelling in both legs also warrants medical review. Treating the appearance of swelling without understanding its cause can miss a problem that needs a different approach.

Where can I discuss persistent leg swelling in Singapore?

For a non-emergency vascular assessment, contact Dr Andrew Choong’s clinic at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. The aim is to understand whether venous disease contributes to the swelling and what further assessment or care is appropriate.

This article provides general education and does not replace an individual medical assessment.

Why Varicose Veins Feel Worse at the End of the Day

Varicose veins can feel more uncomfortable after a long day because blood returning from the legs has to work against gravity. If vein valves leak and the calf muscles have been relatively inactive, pressure can build in the leg veins. Aching, heaviness and ankle swelling may therefore become more noticeable towards evening.

Why does gravity affect the veins in the legs?

Veins return blood towards the heart. In the legs, this means moving blood upwards for much of the day. One-way valves help limit backward flow, and the calf muscles act as a pump when you walk and move your ankles.

The return system works differently from the arteries, which carry blood away from the heart under higher pressure. Veins depend on the interaction between valves, muscles and body position. Long periods spent standing still or sitting with the feet down give the calf pump fewer opportunities to help.

What is venous reflux?

Venous reflux means blood flows backwards through valves that are not closing properly. Blood can collect in the veins and raise the pressure below those valves. Enlarged, twisted veins near the skin may become visible as varicose veins.

The visible veins are only part of the picture. The symptoms someone experiences depend on the underlying flow problem and other factors affecting the leg. You can learn more about varicose veins and venous circulation on our condition page.

Which symptoms may become worse by evening?

Venous symptoms can include heaviness, aching, tiredness, cramping and ankle swelling. Some people notice that their shoes feel tighter later in the day. Others describe a dragging discomfort after standing at work or sitting through a long journey.

A pattern that improves after walking or resting with the legs elevated can be useful information, but it does not prove that varicose veins are the cause. Muscle, joint, nerve and other medical conditions can produce overlapping symptoms. Persistent swelling deserves assessment rather than an assumption based on appearance alone.

Can movement and leg elevation help?

Regular walking and gentle ankle movement encourage the calf muscles to assist venous return. Breaking up long periods of stillness may help reduce the build-up of discomfort. Resting with the legs elevated can also ease symptoms for some people.

These measures may improve comfort, but they do not establish the diagnosis or necessarily correct leaking valves. If symptoms are increasing or affecting daily activities, an assessment can clarify whether a treatable vein problem is present.

Compression stockings may be considered in selected circumstances, but they need an appropriate fit and clinical advice. They are not suitable for everyone, particularly when arterial circulation is impaired, and should not replace an assessment of new or unexplained swelling.

What does a venous duplex ultrasound show?

A duplex ultrasound combines images of the veins with information about blood flow. In someone with suspected varicose vein disease, it can identify reflux and help map the veins involved. That makes it useful for confirming the problem and planning treatment.

The scan follows a clinical assessment. Your history, skin changes, swelling and any previous clot or vein treatment all help determine what needs to be examined. A scan result is interpreted alongside those findings rather than in isolation.

Does everyone with varicose veins need a procedure?

No. The decision depends on symptoms, complications, ultrasound findings and personal preferences. Options may include advice, monitoring or a procedure to treat an affected vein. When intervention is appropriate, the clinician can explain the benefits, limitations and recovery associated with the suitable options.

Changes around the ankle such as persistent itching, discolouration, fragile skin or a wound that is not healing are reasons to seek assessment. Varicose veins are not always just a cosmetic concern.

When should I seek urgent help?

Do not attribute sudden one-sided swelling, pain, redness or warmth to ordinary evening vein discomfort. Seek prompt medical assessment because deep vein thrombosis is one possible cause. If swelling is accompanied by chest pain, sudden breathlessness or collapse, call 995 in Singapore. Bleeding from a varicose vein also requires urgent attention.

Where can I arrange a vein assessment in Singapore?

Contact Dr Andrew Choong’s clinic at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Bring previous ultrasound reports and note when the discomfort occurs, whether one or both legs are affected, and what helps. These details support a focused assessment and an individual care plan.

This article provides general education and does not replace an individual medical assessment.

Arteries vs Veins: What’s the Difference?

Arteries carry blood away from the heart, while veins return blood towards it. That simple distinction helps explain why different circulation problems can produce different patterns of leg pain, heaviness and swelling. Both types of vessel matter, but an arterial problem and a venous problem do not necessarily need the same investigation or treatment.

What do arteries and veins actually do?

Think of arteries as the outward route from the heart and veins as the return route. In the body’s main circulation, arteries deliver oxygen-rich blood to tissues and veins bring blood back after oxygen has been used. The circulation through the lungs is the important exception: pulmonary arteries carry oxygen-poor blood to the lungs, and pulmonary veins return oxygen-rich blood to the heart.

The most reliable definition is therefore the direction of travel, rather than how much oxygen the blood contains. Tiny vessels called capillaries connect the two sides and allow exchange between the blood and surrounding tissues.

Why are the vessel walls different?

Arteries have relatively thick, muscular walls suited to carrying blood under pressure from the heart. Veins operate at lower pressures and have more flexible walls. Many veins in the limbs contain valves that help direct blood towards the heart.

In the legs, returning blood upwards also depends on movement. Contracting muscles help squeeze the veins, while functioning valves limit backward flow. This is why the way symptoms change with walking, standing and rest can provide useful clues during an assessment.

What does an arterial circulation problem feel like?

When leg arteries become narrowed or blocked, the muscles may not receive enough blood for activity. One possible symptom is claudication: an aching or cramping discomfort brought on by walking, often in the calves, thighs or buttocks. It typically eases after stopping to rest.

A recurring pattern matters more than a single episode of cramp. Tell your doctor whether symptoms start after a similar walking distance and whether that distance is becoming shorter. These details can help guide an assessment for peripheral arterial disease.

Leg pain is not always vascular. Joint, muscle and nerve conditions can also affect walking. A description of symptoms helps, but examination and appropriate testing are needed before deciding what is responsible.

How can vein problems cause a different pattern?

In venous reflux, valves do not close effectively and some blood flows backwards. Varicose veins can develop, and the legs may feel heavy, achy or swollen. Symptoms often build after prolonged standing or towards the end of the day. Resting with the legs elevated may help.

These are useful patterns rather than rules that prove a diagnosis. Cramps can occur with both arterial and venous conditions, and a person can have more than one problem at the same time. Learn more about varicose veins and venous disease.

Why does the distinction change treatment?

An arterial assessment asks whether enough blood is reaching the tissues. A venous assessment asks how effectively blood is returning and whether reflux or obstruction is present. A treatment intended for one problem may not address the other.

A vascular consultation may include checking pulses, examining the skin and assessing swelling. Depending on the findings, pressure measurements or an ultrasound may be appropriate. You can read about the broader role of vascular surgery and vascular assessment before your visit.

Which symptoms need urgent assessment?

Seek immediate emergency assessment for a suddenly painful, cold, pale, numb or weak foot. New unexplained swelling in one leg, particularly with pain, warmth or redness, also needs prompt assessment because a blood clot is one possible cause. Chest pain, sudden breathlessness or collapse requires emergency help; call 995 in Singapore.

Where can I have circulation symptoms assessed in Singapore?

For persistent walking pain, leg heaviness or recurring swelling, arrange a consultation with Dr Andrew Choong at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Note what brings symptoms on, how long they last and what relieves them. This information helps the consultation focus on the right next steps.

Aortic Aneurysm Screening: Why Men Over 55 Should Know This

An aortic aneurysm can develop quietly, without an obvious warning. Finding it before an emergency creates an opportunity to measure it, arrange appropriate surveillance and discuss treatment when the balance of risks justifies repair. For men with a smoking history, high blood pressure or a family history of aneurysms, understanding personal risk is a useful starting point.

What is an aortic aneurysm?

The aorta is the main artery carrying blood away from the heart. An aneurysm is an abnormal enlargement of part of this artery as its wall stretches and weakens. It can occur in the chest or the abdomen. An abdominal aortic aneurysm, often shortened to AAA, affects the section in the tummy.

These distinctions matter because the investigation and follow-up depend on the part of the aorta involved. An abdominal ultrasound is commonly used to look for an AAA, but it is not a complete screening test for every condition affecting the chest aorta. Read more about aortic disease and its assessment.

Why can an aneurysm be present without symptoms?

Many aneurysms do not cause pain or a noticeable change in day-to-day health. They may be discovered during an ultrasound or CT scan performed for another reason. Feeling well therefore does not reliably exclude an aneurysm, and waiting for symptoms is not a screening strategy.

The important distinction is between screening someone who feels well and investigating symptoms. New abdominal or back pain requires a clinical assessment appropriate to its severity; it should not simply be booked as a routine screening appointment.

Should every man over 55 have an ultrasound?

No single age threshold applies to everyone. The video’s invitation to men over 55 is a prompt to discuss individual risk, particularly where smoking or family history is relevant. It should not be read as a universal recommendation to screen every man at 55.

Population screening recommendations commonly focus on older men, particularly those with a smoking history. These recommendations help guide a discussion; they do not replace an assessment of your family history, other risk factors and previous scan findings.

In Singapore, a discussion with your doctor can establish whether an ultrasound is appropriate for your circumstances. Bring details of any close relative with an aneurysm, previous imaging and your smoking and blood-pressure history. A family history may justify a discussion earlier than a population screening age.

What happens if an aneurysm is found?

The next step is a plan based on its location, size, growth and any symptoms, alongside your overall health. A small aneurysm may be monitored with repeat imaging. Surveillance means scheduled reassessment, rather than ignoring the finding.

Blood-pressure management and stopping smoking are important parts of care. Your clinician can explain when the next scan is due and which symptoms require urgent attention. Keep a record of the measurements and follow-up arrangements so that changes can be interpreted over time.

Does treatment always mean open surgery?

No. Some aneurysms can be repaired from inside the arteries using a stent graft, an approach known as endovascular repair. Others are better suited to open surgery. Suitability depends on the aneurysm’s anatomy and the person’s health; an operation is not automatically needed just because an aneurysm is discovered.

Early detection does not remove all risk or guarantee a particular treatment. It gives the clinical team more information and time to consider the options. Our aortic awareness information explains why recognition and follow-up matter.

When is urgent help needed?

Sudden severe abdominal or back pain, collapse, loss of consciousness or severe breathing difficulty can signal a life-threatening emergency. Call 995 in Singapore for emergency assistance. Do not wait for a clinic appointment or drive yourself if you are seriously unwell.

Where can I discuss aneurysm screening in Singapore?

For a non-emergency discussion about risk assessment or an existing aneurysm, contact Dr Andrew Choong’s clinic at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Bring previous scan reports and a medication list so that the consultation can focus on a suitable assessment and follow-up plan.

This article provides general education and does not replace an individual medical assessment.

Varicose Veins Are Not Just Cosmetic

Varicose veins are not always just a cosmetic concern. Bulging veins can be a sign that the one-way valves in the leg veins are not working effectively. For some people, this is associated with aching, heaviness or swelling; others notice changes to the skin around the ankle.

In this video, I explain how the leg veins return blood to the heart, what happens when their valves fail and why an ultrasound assessment can be useful. The starting point is understanding your symptoms: not all varicose veins need treatment.

How do the veins in your legs work?

Arteries carry blood away from the heart, while veins return it. In the legs, returning blood has to move upwards against gravity. When you walk, your calf muscles squeeze the veins and help push blood towards the heart. A series of one-way valves helps prevent it from flowing backwards.

This differs from the arterial problem described in my previous video about leg pain when walking and claudication. Both affect circulation, but the underlying problem and the assessment are different.

What is venous reflux?

Venous reflux means that blood flows backwards through veins whose valves are not closing properly. This can increase pressure in the veins, particularly when you are standing. Superficial veins may become enlarged and twisted, producing the visible bulges we call varicose veins.

The appearance alone does not tell us how much reflux is present or whether treatment would help. I consider the symptoms, skin changes and ultrasound findings together when assessing varicose veins and venous disease.

Which symptoms deserve a closer look?

Symptoms and changes associated with venous disease can include:

• Heaviness or aching: legs that feel uncomfortable, especially after prolonged standing.

• Swelling: often noticeable around the ankle or lower leg.

• Bulging veins: enlarged veins visible beneath the skin.

• Skin changes: brownish discolouration, itching or eczema around the lower leg.

• Ulceration: a break in the skin that may be slow to heal in more advanced disease.

These findings are reasons to seek an assessment, rather than assume the problem is only cosmetic. They can also have other causes, so symptoms or photographs alone cannot confirm venous reflux.

What does a duplex ultrasound show?

A venous duplex ultrasound is a non-invasive scan that uses sound waves to examine the veins and the direction of blood flow. It can identify reflux and help map which veins are affected. This information supports the diagnosis and, where appropriate, treatment planning.

During the consultation, I would also ask when your symptoms started, what makes them worse and whether you have had previous vein treatment or blood clots. The examination and scan findings help determine the next step.

Do all varicose veins require treatment?

No. Mild or symptom-free varicose veins may need advice and observation. If symptoms affect daily life, or there are skin changes or ulcers, treatment options can be discussed in more detail.

Depending on the findings, management may include suitable activity, leg elevation, appropriately prescribed compression or a procedure to treat refluxing veins. Compression can help selected symptoms, but it does not repair faulty valves and should be chosen with your circulation and other health conditions in mind. Treatment is individual; a visible vein does not automatically mean an operation is necessary.

When is leg swelling more urgent?

Longstanding venous symptoms are different from new swelling in one leg, particularly with pain, warmth or tenderness. This needs urgent medical assessment for possible deep vein thrombosis (DVT). Do not assume a sudden change is simply your usual varicose veins.

Sudden breathlessness, chest pain or fainting requires emergency care. In Singapore, call 995 for a life-threatening emergency rather than waiting for a clinic appointment.

Varicose vein assessment in Singapore

If aching, swelling or skin changes sound familiar, contact Andrew Choong Vascular Surgery to discuss an assessment at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

This article provides general education and does not replace an individual medical assessment.

Leg Pain When Walking? It Could Be Claudication | Dr Andrew Choong

Leg pain when walking is not always caused by arthritis or simply getting older. A cramping, aching or tight feeling in the calf, thigh or buttock that repeatedly appears during walking and improves with rest can be a sign of intermittent claudication, a symptom of reduced blood flow to the leg muscles.

In the video above, I explain three simple questions that can help you describe this pattern. They cannot diagnose the cause of your pain, but they can help you recognise when a vascular assessment may be useful.

Three questions to ask about leg pain when walking

1. Does it begin after a fairly predictable walking distance? You may notice discomfort after a similar stretch of pavement or on the same hill.

2. Does it ease when you stop walking? Claudication commonly improves after a few minutes of rest.

3. Does it return when you start walking again? The same discomfort may recur as your leg muscles work harder.

If this sounds familiar, arrange a medical assessment. The pattern can suggest claudication, but joint, muscle and nerve problems can also cause leg pain. An examination helps distinguish between them.

Why can poor circulation cause this pain?

Walking increases the amount of oxygen your leg muscles need. If arteries supplying the legs are narrowed, blood flow may not increase enough to meet that demand. Stopping reduces the muscles’ oxygen needs, allowing the discomfort to settle.

This narrowing is often caused by atherosclerosis, a build-up of fatty plaque inside artery walls. When it affects the arteries supplying the limbs, it is called peripheral arterial disease (PAD). Not everyone with PAD has the classic walking-and-rest pattern.

Why does claudication matter for heart health?

When claudication is caused by PAD, the assessment also considers your wider cardiovascular health. PAD and coronary artery disease often share the same underlying process, and people with PAD have a higher risk of heart attack and stroke.

Smoking, diabetes, high blood pressure and high cholesterol are relevant risk factors. Reviewing them is part of caring for your circulation, even if your main concern is walking discomfort.

How is claudication assessed?

I would start by asking where the pain occurs, what brings it on, how quickly it settles and whether your walking distance has changed. Your medical history, medicines and risk factors also help guide the assessment.

An examination includes checking your feet, skin and leg pulses. An ankle–brachial pressure index (ABPI), also called ABI, compares blood pressure at the ankles and arms. A duplex ultrasound may be appropriate to assess blood flow and locate narrowing. Further tests depend on the findings; not everyone needs a scan.

Does claudication always need an operation?

No. Treatment often begins with managing cardiovascular risk, stopping smoking where relevant, prescribed medicines and a structured exercise programme suitable for the individual. Medicines may address cholesterol, blood pressure or blood-clotting risk.

For stable claudication, supervised or clinician-supported walking programmes can improve walking ability. The programme should follow assessment and account for other health conditions. New severe pain, pain at rest or a cold, numb foot should not be treated by simply pushing through a walk.

Angioplasty or surgery may be considered when symptoms remain significantly limiting despite treatment, or when circulation is severely compromised.

When should you seek urgent help?

Seek prompt medical assessment for new pain at rest, a foot or leg wound that is not healing, or symptoms that are worsening, particularly if you have diabetes.

A suddenly painful, cold, pale, numb or weak leg or foot needs emergency assessment. Seek emergency care immediately rather than waiting for a clinic appointment.

Vascular assessment in Singapore

If recurring walking pain is limiting your daily activities, contact Andrew Choong Vascular Surgery to discuss an assessment at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

This video follows my introduction to September’s vascular disease awareness series. Recognising a symptom pattern is a useful first step; a clinical assessment establishes what it means for you.

This article provides general education and does not replace an individual medical consultation.

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.