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.

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.

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.

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.

President Trump’s Chronic Venous Insufficiency: A Vascular Surgeon Explains

In a public memorandum dated 17 July 2025, the White House physician reported that President Donald Trump had been assessed for mild swelling in his lower legs. The statement said venous Doppler ultrasound showed chronic venous insufficiency, with no evidence of deep vein thrombosis or arterial disease.

That announcement brought a common circulation problem into the news. In my video, I explain the medical terms and what they can mean for patients. I am Dr Andrew Choong, a vascular surgeon in Singapore. The useful lesson is how leg veins work, why they sometimes struggle and how an assessment helps identify the cause of swelling.

What is chronic venous insufficiency?

Chronic venous insufficiency means the veins are not returning blood from the legs as effectively as they should. Normally, the calf muscles help push blood upwards, while valves in the veins help prevent it from flowing backwards.

When valves do not work properly, backward flow—called reflux—can allow blood to pool and raise pressure in the leg veins. Previous vein damage or obstruction may also contribute. The result can be swelling, heaviness, aching or changes in the skin.

Arteries and veins do different jobs. Arteries deliver blood to the legs; veins return it towards the heart. Venous insufficiency should therefore not be confused with a narrowing or blockage of the leg arteries.

Is chronic venous insufficiency always harmless?

It covers a range of severity. Some people have relatively mild symptoms. Others develop persistent swelling, skin irritation, pigmentation or a venous ulcer, often around the ankle.

That range is why the word “common” should not be taken to mean that every patient can ignore symptoms. The appropriate response depends on how the veins are functioning, the effect on daily life and whether skin damage is developing.

Varicose veins and venous disease are related, but visible veins do not tell the whole story. A leg can look different from another person’s leg and still require an individual assessment.

What does a venous duplex ultrasound show?

A duplex scan combines images of the veins with an assessment of blood flow. It can help identify backward flow through faulty valves and look for obstruction or clot, according to the clinical question being investigated.

In practice, the scan needs to be interpreted alongside symptoms and examination. Understanding where a problem begins helps determine whether advice, compression or a vein procedure is appropriate. Treatment should address the underlying findings, rather than rely only on what is visible at the skin’s surface.

Does leg swelling mean there is a blood clot?

No. Swelling has several possible causes, including venous insufficiency, but deep vein thrombosis is an important possibility when a leg becomes newly swollen or painful. A clinician assesses the pattern, timing and personal risk factors before choosing tests.

Blood tests such as D-dimer are not stand-alone answers for everyone. Their usefulness depends on the likelihood of a clot before testing and the rest of the assessment. A reported normal result should not be used to dismiss new symptoms in a different person.

New unexplained one-sided swelling needs prompt assessment. Sudden breathlessness, chest pain, fainting or collapse may signal a pulmonary embolism or another emergency; call 995 in Singapore for severe emergency symptoms.

How can chronic venous insufficiency be managed?

Management is tailored to the cause and severity. Movement, measures to reduce prolonged immobility, and appropriately selected compression may help some patients. Compression needs clinical consideration when there may also be arterial disease.

For suitable patients with superficial venous reflux, a procedure to treat the affected vein may be discussed. Options depend on the scan findings, symptoms and overall health. Skin changes or an ulcer also require a plan for local care and follow-up.

For a non-emergency discussion about swelling, varicose veins or venous symptoms, contact Andrew Choong Vascular Surgery. Current clinic location: Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.