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.

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.

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? 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.

World Diabetes Day 2025: Diabetes, Artery Health and Foot Care

Diabetes can affect the blood vessels long before a person notices a circulation problem. For World Diabetes Day, my video explains why looking after your arteries belongs alongside managing blood glucose. The aim is to recognise risk early, identify problems that need treatment and protect long-term health.

A circulation assessment is most useful when it answers a clear clinical question. It should be guided by symptoms, examination and individual risk, with a plan for what the findings will change.

How can diabetes damage the arteries?

Persistently high blood glucose can damage blood vessels and contribute to atherosclerosis, the build-up of plaque within artery walls. Blood pressure, cholesterol, smoking and other factors also influence risk. As arteries become narrowed, less blood may reach the tissues they supply.

The consequences depend on the location. Arterial disease can contribute to heart attacks, strokes and reduced blood flow to the legs and feet. In the legs, this is known as peripheral arterial disease, or PAD.

Diabetes does not mean that every artery is blocked. It means that vascular risk deserves active attention, even when someone feels well.

Why are the feet especially important?

Two problems can occur together: reduced circulation and nerve damage. Poor circulation can make wounds harder to heal. Nerve damage can reduce sensation, so a blister, pressure injury or small cut may go unnoticed.

This is why pain alone is an unreliable warning system. A foot can need attention even if it does not hurt. Look over both feet regularly, including the soles and between the toes, and seek help if you cannot examine them yourself. Appropriately fitting footwear and regular foot reviews are also important.

A diabetic foot ulcer is a serious complication, but it is not a prediction that an amputation is inevitable. Prompt assessment, infection treatment when needed, pressure relief and attention to circulation can all form part of a coordinated care plan.

What can an ABPI or arterial duplex ultrasound show?

An ankle–brachial pressure index, also called ABPI or ABI, compares blood pressure at the ankle with blood pressure in the arm. It helps assess whether arterial narrowing may be reducing blood flow to the legs.

Diabetes can make arteries stiff and difficult to compress. This can produce a normal-looking or high ankle pressure despite underlying disease. A normal ABPI therefore does not rule out PAD by itself in someone with diabetes.

Arterial duplex ultrasound uses sound waves to examine arteries and blood flow. Depending on the findings, other measurements, such as toe pressures, may also be helpful. These tests assess particular aspects of circulation; they do not provide a single all-clear for every artery in the body.

Does everyone with diabetes need the same vascular tests?

No. The assessment should start with the history and examination, including symptoms, foot condition, pulses and previous ulcers or vascular disease. Your clinician can then decide which tests are appropriate and whether a specialist review is needed.

Tell your care team about calf discomfort when walking, a change in walking distance, persistent foot pain, colour changes or a wound that is slow to heal. An absence of typical walking pain does not exclude a circulation problem.

When should a foot problem be checked urgently?

A new ulcer, spreading redness, discharge or a hot, swollen foot needs prompt medical assessment. Seek emergency care for a suddenly cold, pale or numb foot, severe new pain, blackened tissue or a foot infection accompanied by fever or feeling seriously unwell. Do not wait for a routine appointment if the foot is deteriorating.

What helps protect vascular health over time?

Work with your usual care team on blood glucose, blood pressure and cholesterol, take prescribed treatment consistently and seek support to stop smoking if needed. Combine these measures with foot care and physical activity suited to your condition.

For concerns about diabetes and leg circulation, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. An individual assessment can help clarify the next step.