Five Vascular Warning Signs You Should Not Ignore

Leg pain when walking, a swollen calf, a foot wound that will not heal and troublesome varicose veins can all warrant a vascular assessment. Sudden severe chest, back or abdominal pain is different: it may be an emergency and must not wait for a clinic appointment.

To close his September vascular awareness series, Dr Andrew Choong describes five patterns worth recognising. These symptoms do not prove a particular diagnosis. Knowing what to do next helps you seek the right care at the right time.

For sudden severe chest, back or abdominal pain, collapse, stroke symptoms or a suddenly cold, painful or weak limb, call 995 in Singapore or your local emergency number elsewhere. Do not wait for a WhatsApp reply or travel to Singapore for a planned consultation.

1. Leg Pain When Walking That Improves With Rest

Repeated aching, cramping or tightness in the calf, thigh or buttock during walking may be claudication. This can occur when peripheral arterial disease (PAD) limits blood flow to working muscles. The discomfort often settles when you stop, then returns when you walk again.

Similar symptoms can come from joints, nerves or muscles. An assessment helps distinguish these causes and considers smoking, diabetes, cholesterol, blood pressure and kidney disease. Stable walking symptoms usually allow a planned review. New pain at rest or a sudden change in the foot’s temperature, colour, sensation or strength needs more urgent attention.

Treatment is not automatically an operation. Risk-factor management, prescribed medicines and structured exercise are important. Angioplasty or stenting may be considered in selected patients after reviewing the symptoms, anatomy, alternatives and risks.

2. A Painful, Swollen Calf, Especially on One Side

A new swollen, painful or tender calf can be a sign of deep vein thrombosis (DVT), a clot in a deep vein. Other conditions can cause swelling too, and DVT cannot be confirmed or excluded from appearance alone.

Seek urgent medical assessment for a suspected DVT, rather than waiting for a routine appointment. Tell the clinician when symptoms began and about recent travel, surgery, reduced mobility, illness or previous clots. Clinical assessment and appropriate testing establish the diagnosis and guide DVT treatment.

New breathlessness, chest pain, coughing blood or fainting may indicate a pulmonary embolism. Seek emergency care immediately; call 995 in Singapore for these potentially life-threatening symptoms.

3. A Foot or Toe Wound That Is Not Healing

A persistent wound may involve more than the skin. Reduced arterial blood flow can limit healing, while pressure, infection and reduced sensation may also contribute. This is particularly important in people with diabetes or kidney disease.

Do not wait for a small wound to become painful or black before seeking help. Diabetic foot and wound assessment considers the circulation alongside infection and pressure on the foot. Fever, spreading redness, blackened tissue, rapidly worsening pain or feeling unwell needs urgent medical attention.

A dressing alone will not resolve every underlying problem. Treatment may combine wound care, pressure relief, infection management and, when needed, restoration of blood flow. The plan depends on the individual findings; no procedure guarantees wound healing.

4. Varicose Veins With Symptoms or Skin Changes

Varicose veins are not always cosmetic. Heaviness, aching, swelling, skin darkening, eczema or an ulcer can indicate clinically important venous disease. Chronic venous insufficiency can affect the skin around the lower leg and ankle.

A vascular review can check for reflux, where faulty vein valves allow blood to flow backwards. Duplex ultrasound helps guide treatment when appropriate. Depending on the findings, options may include measures to manage symptoms or a procedure such as radiofrequency or laser ablation.

Bleeding from a varicose vein needs immediate medical attention. Heavy or uncontrolled bleeding is an emergency: call 995 in Singapore. Do not dismiss an episode simply because it has stopped.

5. Sudden Severe Chest, Back or Abdominal Pain

Sudden severe or unusual pain in these areas can have several serious causes. Occasionally it signals an aortic emergency, such as dissection or a complication of an aneurysm. Pain may be described as tearing, but it does not have to feel that way to be dangerous.

Call emergency services immediately. A routine vascular booking is not the correct first step. If you have a known aneurysm, tell the emergency team. The aortic disease guide explains surveillance and treatment planning for people who are stable; it does not replace emergency assessment.

What to Bring to a Planned Vascular Review

Bring previous scan images and reports, a medication list, details of earlier procedures and a short history of the symptoms. Note what brings them on and how they affect walking or daily activities.

For non-emergency advice or a second opinion, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, Singapore. See how to prepare for your visit and watch the five vascular warning signs video.

Ankle Skin Darkening: A Warning Sign of Vein Disease

Brown staining, itching or thickened skin around the ankle can be a warning sign of chronic venous disease. When vein valves fail, pressure can build in the lower leg and gradually affect the skin. These changes deserve assessment, particularly when accompanied by swelling, aching or varicose veins.

In this video, Dr Andrew Choong, vascular and endovascular surgeon in Singapore, explains why checking the veins before the skin breaks down can be useful. Not every dark patch is caused by a circulation problem, so identifying the cause matters.

How can vein disease change the skin?

Leg veins return blood towards the heart. Their valves help keep blood moving in the right direction. When those valves become inefficient, blood can flow backwards: this is called venous reflux.

Over time, increased venous pressure can produce swelling and skin changes around the ankle. The skin may become brown, dry, itchy, inflamed, tight or fragile. Some people first notice heaviness or aching; others notice the skin change before seeking advice about their varicose veins.

Does dark skin mean an ulcer will develop?

No. Ankle pigmentation does not mean that an ulcer is inevitable. It can, however, be a sign that venous disease is affecting the skin, rather than simply changing the appearance of the veins.

Venous eczema describes inflamed, itchy skin associated with vein disease. More advanced changes can include hardening of the skin and underlying tissue, called lipodermatosclerosis. Fragile skin may eventually break down into a venous leg ulcer. Our chronic venous insufficiency and leg ulcer guide explains this spectrum.

What should a vascular assessment check?

The assessment brings together the pattern of skin changes, symptoms, previous blood clots or vein treatment, and an examination of the leg. A venous duplex ultrasound can assess reflux and how the superficial and deep veins are working.

A history of deep vein thrombosis is relevant because previous clots may affect venous drainage. Skin disorders and other medical causes also need consideration. An ankle photograph alone cannot establish that reflux is responsible.

Will cream or compression stockings be enough?

Skin care can help irritation, and appropriately prescribed compression may be part of treatment. Neither should replace an assessment when the cause of persistent changes is unclear.

The plan depends on the findings. For suitable superficial reflux, options may include endovenous ablation, foam sclerotherapy or other vein treatment. The choice also considers symptoms, skin condition and overall health. Treating reflux does not guarantee that established pigmentation will disappear.

When should you arrange a review?

Arrange assessment if ankle skin is progressively darkening, itchy or thickened, especially with swelling, heaviness or visible veins. If the skin has already broken down or a wound is not healing, seek prompt medical review rather than repeatedly changing creams or dressings without checking the cause.

Contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, Singapore, for an individual assessment. You can also watch the explanation of ankle skin changes in the video library.

Modern Varicose Vein Treatment: Walking the Same Day

Many suitable patients can walk and go home on the same day after modern varicose vein treatment. This does not mean there is no recovery, or that everyone can immediately return to strenuous activity. Your vein anatomy, treatment and general health determine the aftercare plan.

In this video, Dr Andrew Choong, vascular and endovascular surgeon in Singapore, explains how modern endovenous techniques have changed recovery, and why choosing the right treatment still matters.

What is modern endovenous treatment?

Endovenous means treating a vein from inside it. Ultrasound guides the procedure, usually through small access points, rather than the larger incisions associated with some open operations.

For suitable refluxing veins, options include radiofrequency ablation, which uses heat, and selected non-thermal approaches such as vein glue treatment. These techniques have different suitability criteria and risks. A scan and discussion come before choosing a device or technique.

Can you really walk on the same day?

Dr Choong explains that many patients in his practice are walking, discharged and resuming ordinary daily activities quickly after treatment. This describes suitable patients; it is not a guaranteed timetable for every procedure.

Walking around at home is different from a long shift on your feet, a strenuous gym session or a long-haul flight. Ask for advice that reflects your work, travel plans and the treatment actually performed.

What does recovery involve?

Expected discomfort and support

Bruising, tenderness, tightness or a pulling sensation can occur. Compression stockings may be recommended, with instructions tailored to the procedure and your needs. Keep the planned follow-up appointments so recovery can be assessed.

Exercise, heat and travel

Before treatment, discuss heavy exercise, prolonged standing, hot baths and flying. Avoid assuming that another patient's advice applies to you. Your surgeon should explain when to resume each activity and whom to contact if recovery is not going as expected.

Does open vein surgery still have a role?

Yes. Modern care means selecting the appropriate treatment, including open surgery when it is the better fit. Some patients need treatment of the main refluxing vein; others also need troublesome surface branches addressed.

Options may include foam sclerotherapy, microphlebectomy to remove bulging vein branches, open varicose vein surgery or a combination. Open surgery may involve a longer recovery. The least invasive option is useful only when it also suits the clinical problem.

Plan treatment around your veins and daily life

A proper varicose vein assessment considers symptoms, previous procedures, skin changes and ultrasound findings. Read why scanning comes before treatment.

For an individual plan, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, Singapore. You can also watch the short explanation of treatment and recovery. The goal is a suitable treatment and safe return to activity, rather than a universal promise of no downtime.

Bleeding Varicose Veins: What To Do

If a varicose vein starts bleeding, lie down, raise the leg and apply firm, direct pressure over the bleeding point with a clean cloth or dressing. Heavy or persistent bleeding, or feeling faint, needs emergency help. Even if the bleeding stops, arrange urgent medical assessment because it can happen again.

In this video, Dr Andrew Choong, vascular and endovascular surgeon in Singapore, explains the first steps and why a bleeding vein deserves more than a dressing.

What should you do immediately?

1. Lie down and lift the affected leg. This helps reduce pressure in the veins.

2. Press firmly directly on the bleeding point. Use a clean cloth or dressing and maintain pressure; do not keep lifting it to check.

3. Get medical help. Call 995 in Singapore if bleeding is heavy, will not stop or you feel faint. Continue direct pressure while help is arranged.

If you take blood thinners, seek urgent medical advice after any bleeding episode. Tell the treating team which medicines you take.

Why can varicose veins bleed?

Varicose veins are enlarged superficial veins. When their valves do not work properly, blood can flow backwards, a problem called venous reflux. Pressure can build in the lower leg, and the skin over a vein may become thin or fragile.

A small break in that skin can therefore produce surprisingly brisk bleeding. It is not necessarily a large visible vein that causes the problem. Associated swelling, brown ankle skin or an ulcer can signal chronic venous insufficiency.

Does it still need assessment if it stops?

Yes. Stopping the bleeding does not establish that the underlying vein problem has resolved. Seek prompt assessment even after a first episode. Do not wait for another bleed or a routine appointment weeks later.

The assessment considers where the bleeding occurred, previous episodes, skin changes and medicines. A venous duplex ultrasound maps blood flow and identifies reflux in the superficial and deep veins. This helps establish which veins are responsible and what treatment is appropriate.

How can treatment reduce the risk of another bleed?

The immediate priority is controlling the bleeding. After that, treatment addresses the responsible vein and any underlying reflux. Depending on the scan and clinical findings, options may include injection or foam sclerotherapy, endovenous radiofrequency ablation or another suitable vein procedure.

There is no single operation for every bleeding vein. The location, anatomy, skin condition and general health guide the choice. The aim is to lower the risk of recurrence, without promising that further bleeding can never occur.

Assessment in Singapore

Once urgent care has been arranged, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre for follow-up assessment. Bring your medication list and any previous vein scan reports. You can also watch this explanation in the video library.

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.

Further guides cover microphlebectomy for surface branches and ligation and stripping, including selection, risks and recovery.

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.

Read our vascular duplex ultrasound guide for more about the scan, preparation and how results are discussed.

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.

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.

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.

September is Vascular Disease Awareness Month | Signs & Symptoms

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

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

What is vascular disease?

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

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

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

Which symptoms should you look out for?

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

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

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

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

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

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

Can vascular disease be silent?

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

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

When should you seek urgent help?

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

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

When is a vascular assessment appropriate?

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

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

Follow the September vascular health series

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

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

Vascular care in Singapore

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

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

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

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

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

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

What is the difference between an artery and a vein?

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

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

Which conditions does a vascular surgeon treat?

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

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

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

• Venous disease: varicose veins and deep vein thrombosis.

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

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

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

Is vascular surgery the same as cardiology?

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

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

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

Does seeing a vascular surgeon mean I need an operation?

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

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

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

When should I seek a circulation assessment?

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

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

Where can I discuss vascular symptoms in Singapore?

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

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

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.