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.

World Heart Day: Heart Attack, Brain Attack, Leg Attack

World Heart Day is a reminder to look beyond the heart. The arteries supplying the brain, legs and feet can be affected by the same process of plaque build-up that contributes to heart disease. In this video, Dr Andrew Choong explains why leg symptoms can be an important warning about the wider circulation.

Possible heart attack, stroke or sudden loss of circulation to a limb requires emergency care. Call 995 in Singapore, or your local emergency number elsewhere. Do not wait for a clinic appointment or a WhatsApp reply.

Heart Attack, Brain Attack and Leg Attack: What Is the Connection?

Arteries carry oxygen-rich blood from the heart to the body. Atherosclerosis is the build-up of plaque within their walls. It can narrow an artery, and a clot can sometimes suddenly block blood flow. The effect depends on which part of the body loses its blood supply.

• Heart: a blocked coronary artery can cause a heart attack.

• Brain: a blocked artery can cause an ischaemic stroke, sometimes called a brain attack. Not every stroke is due to blockage; bleeding can also cause a stroke.

• Legs and feet: narrowed or blocked arteries can cause peripheral arterial disease (PAD). Severe loss of blood supply can threaten the foot or leg.

These connections do not mean that everyone with leg pain has heart disease or will have a stroke. They mean that confirmed PAD deserves attention to both the leg and overall cardiovascular risk. Carotid artery disease, affecting the neck arteries supplying the brain, is another part of this wider picture.

What Does “Leg Attack” Mean?

“Leg attack” is an awareness phrase rather than a precise diagnosis. In the video, it draws attention to a foot threatened by severely impaired circulation: pain at rest, a wound that does not heal, blackened toes or infection. The established term for longstanding severe arterial insufficiency of this kind is chronic limb-threatening ischaemia (CLTI).

This differs from acute limb ischaemia, where blood flow falls suddenly. A suddenly painful, cold or pale foot, particularly with new numbness or weakness, is an emergency. A longstanding problem can also deteriorate abruptly. Neither situation should be managed by waiting to see whether an exercise programme helps.

Persistent foot pain at rest, an ulcer or blackened tissue needs urgent assessment. Fever, spreading infection or rapidly worsening symptoms make immediate medical attention particularly important. Read about diabetic foot and wound care for the relationship between circulation, infection and healing.

Why the Same Risk Factors Matter

Dr Choong highlights smoking, diabetes, high blood pressure, high cholesterol, kidney disease, excess weight, inactivity and an unhealthy diet. These can affect more than one area of the arterial circulation.

Smoking and diabetes are particularly important in PAD. A person with diabetes may also have reduced sensation, so a serious foot problem may cause less pain than expected. High blood pressure is an important stroke risk factor. Managing these risks is relevant even when the symptom that first brings someone to the clinic is in the leg.

Care may include help to stop smoking, appropriate activity, foot care and prescribed treatment for blood pressure, cholesterol and diabetes. Medicines and exercise plans should be individualised; do not start or stop blood-thinning medicine on the basis of a video.

When Should Leg Symptoms Be Assessed?

Recurring calf, thigh or buttock discomfort during walking that improves after stopping can be claudication. It is worth assessing rather than assuming it is simply age or poor fitness. Joint, nerve and muscle conditions can cause similar symptoms, so the pattern alone does not establish PAD.

An assessment reviews the symptoms, risk factors, pulses and feet. Depending on the findings, ankle or toe pressure measurements and vascular ultrasound may help assess circulation. Further imaging is selected when it will guide care; not everyone needs every test.

Many patients with stable walking symptoms begin with medicines, risk-factor management and structured exercise. For selected patients with a threatened foot or continuing major limitations, leg angioplasty and stenting or bypass surgery may be discussed. The decision depends on the circulation, overall health, likely benefit and risks.

Act on Warning Signs; Plan Non-Emergency Care

Chest discomfort with breathlessness, sweating or collapse, or sudden facial weakness, arm weakness or speech difficulty, needs emergency assessment. Stroke symptoms that disappear still need urgent emergency evaluation.

For stable leg symptoms or a planned second opinion, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, Singapore. Bring previous scan images, reports and a medication list; the visit preparation guide can help. You can also watch the World Heart Day video or explore the short explanation of walking-related leg pain.

DVT Treatment Window: When Blood Thinners May Not Be Enough

Blood thinners are the main treatment for most deep vein thromboses (DVTs). In selected patients with an extensive clot affecting the large veins near the groin or pelvis, early assessment may also identify a role for clot removal or treatment of an underlying narrowing. The decision depends on symptoms, clot anatomy, timing and the risks of treatment.

In this video, Dr Andrew Choong, vascular and endovascular surgeon in Singapore, explains why a new DVT and persistent problems after an old DVT need different assessments.

Sudden breathlessness, chest pain, coughing blood or fainting may indicate a pulmonary embolism. Seek emergency care immediately; call 995 in Singapore for life-threatening symptoms. Do not wait for a routine appointment or an online reply.

What do blood thinners do for a DVT?

A deep vein thrombosis is a clot in a deep vein, commonly in the leg. Anticoagulants, often called blood thinners, reduce further clotting and help prevent the clot from growing or travelling to the lungs. They remain essential treatment for many patients.

They do not directly remove the clot or repair a scarred vein. The body gradually deals with the clot, and recovery varies. Some patients recover well with medication and follow-up; others have significant obstruction or persistent symptoms that warrant further assessment. Continue prescribed treatment and discuss any changes with your treating clinician.

When might early clot removal be considered?

The location matters. An iliofemoral DVT involves the iliac veins in the pelvis and/or the common femoral vein near the groin. Extensive clot in these veins can interfere substantially with blood draining from the leg, particularly when swelling and pain are severe.

Assessment considers:

• Where the clot is and how much of the vein is affected.

• When symptoms began and whether they are improving or worsening.

• The effect on walking, daily activity and the condition of the leg.

• Bleeding risk, recent surgery, other illnesses and the patient's preferences.

Selected patients with recent, symptomatic iliofemoral DVT may benefit from a discussion about early clot removal. For clot limited to veins farther down the thigh, behind the knee or in the calf, clot removal is generally not recommended. Severe, rapidly worsening swelling or pain with a marked change in leg colour needs emergency assessment.

What does the treatment window mean?

A fresh clot and longstanding scar tissue are different problems. Some clot-directed treatments are most relevant early, before the clot becomes more organised. This is why a newly diagnosed DVT with a very swollen, painful leg deserves prompt review of both the initial treatment and the clot's extent.

There is no single deadline that tells every patient whether a procedure will help. The technique, symptom duration, scan findings and overall health all matter. Seeking advice promptly preserves the opportunity to consider suitable options; it does not mean every patient needs an intervention.

What treatments may be discussed?

As Dr Choong explains, options in carefully selected cases include catheter-directed treatment, thrombectomy, venoplasty and venous stenting. Catheter-directed thrombolysis delivers clot-dissolving medicine into the clot. Thrombectomy uses a device to remove clot. If an important underlying vein narrowing is identified, a balloon or stent may sometimes be considered to improve drainage.

These approaches have different risks and evidence. Thrombolysis can cause major bleeding, and other procedures also have complications. Removing clot does not guarantee that post-thrombotic syndrome will be prevented, and anticoagulation usually remains part of care after an intervention. The DVT treatment guide explains how medication, selected procedures and follow-up fit together.

Why can symptoms persist months or years later?

A previous DVT can leave residual obstruction, vein scarring or damaged valves that allow backward flow, called reflux. The leg may remain swollen, heavy or painful. Skin around the ankle can darken, and some people develop venous ulcers. These problems may form part of post-thrombotic syndrome (PTS).

PTS can develop despite appropriate treatment. Persistent symptoms do not automatically mean that the original clot was treated incorrectly, that a new clot is present, or that a procedure is required. New or suddenly worsening symptoms need prompt assessment rather than being assumed to be the old problem.

A review asks whether there is residual blockage, pelvic vein narrowing, reflux or another explanation. Duplex ultrasound helps assess the veins; further imaging is selected when needed. Comparing previous scans can help distinguish longstanding changes from a new concern.

Preparing for a vascular review

Bring the date symptoms started, previous scan reports and images, hospital discharge information, and an up-to-date medication list. Describe how symptoms affect standing, walking, work and skin care. The aim is to understand the problem and discuss realistic options, including care without a procedure.

For ongoing symptoms after DVT or a discussion of an existing treatment plan, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, Singapore. A new suspected DVT needs urgent medical assessment. You can also watch Dr Choong's short explanation of the DVT treatment window.

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

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

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

Which records should I send or bring?

Gather the information relevant to your current vascular problem:

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

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

• Previous operation notes and hospital discharge summaries.

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

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

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

Why are the actual CT images important for aortic disease?

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

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

What helps with leg wounds, swelling or vein problems?

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

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

Should I travel if symptoms are sudden or severe?

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

Plan your consultation in Singapore

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

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.

EVAR for Aortic Aneurysms: A Pipe Within a Pipe

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

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

What is an aortic aneurysm?

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

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

How does EVAR work?

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

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

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

The EVAR treatment guide explains assessment, risks, alternatives and recovery in more detail.

Who may be suitable for EVAR?

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

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

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

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

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

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

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

How does EVAR compare with open repair?

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

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

Why are follow-up scans important?

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

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

Should you discuss aneurysm screening?

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

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

Aortic aneurysm assessment in Singapore

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

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

Thank You: One Month at Andrew Choong Vascular Surgery

One month into Andrew Choong Vascular Surgery, I wanted to pause and say thank you. I recorded this message on 1 July, a month after the clinic opened, and the video was published on 2 July.

Starting a specialist practice has involved much more than opening the doors. It has also been a reminder of how many people contribute to caring for each patient. I am grateful to everyone who has supported this first month in Singapore.

Thank you for your trust and support

To the patients who have entrusted me with their care, thank you. Seeking advice about a vascular problem can come with questions and uncertainty, and I appreciate the trust involved in that first consultation and each decision that follows.

Thank you also to the GPs and specialist colleagues who have referred patients, and to the nursing and allied health colleagues whose work supports their care. To my friends and family, your encouragement, messages, flowers and good wishes have meant a great deal.

Building the clinic around patient care

If I have been quieter on social media, this is why. Building a practice from scratch has meant renovating the clinic, recruiting and training the team, and establishing the systems and workflows that help each day run smoothly.

It has also meant introducing technology thoughtfully, with a focus on safe, efficient and patient-centred care. Those foundations are less visible than a video or a clinic sign, but they matter to the experience of the people coming through our doors.

A broad first month of vascular care

The first month has included care across the range of vascular conditions: varicose veins and other venous problems, deep vein thrombosis and pulmonary embolism, peripheral arterial disease, dialysis access, carotid disease, and aortic aneurysms and more complex aortic conditions.

That variety reflects the breadth of vascular surgery. The right approach depends on the person and the condition, with time to discuss what an assessment or treatment involves.

More practical vascular education ahead

As we find our rhythm, I hope to return to sharing educational videos more regularly. I want to address common questions, explain vascular conditions in everyday language, and discuss practical steps that help people understand their health before a problem becomes serious.

You can learn more about my practice and approach, or contact the clinic at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

Thank you again for being part of this first month. I am grateful for your support and look forward to the work ahead.

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.