Darren Kowalski, MD, FACS – Surgery/ Vein Clinic
Do you have bulging or unsightly veins? Leg pain, burning or fatigue? You’re not alone. Whether your vein issues are cosmetic or reflect a more serious medical concern, the Summit Medical Group Oregon – BMC Vein Clinic is ready to assist you with various treatment options.
Varicose & Spider Veins: What are they and why should you be concerned?
Varicose veins are veins that have become enlarged and twisted. Spider veins are dilated capillaries on the skin that resemble a spider’s legs. Varicose and spider veins are very common and afflict an estimated 20-25 million people in the United States. Veins bring blood back to the heart. To do this, each vein has a series of valves that helps the blood move through the body. When the valves fail, the veins enlarge and become over-pressurized. This leads to skin problems, vein appearance and pain.
Risk Factors
Although varicose veins can affect anyone, common risk factors include:
- Family history of vein problems
- Age
- Being of female gender
- Obesity
- Smoking
- Pregnancy
- History of prior blood clots
Symptoms
- Feeling of heaviness, fatigued legs – particularly after a long day of sitting or standing
- Burning or cramping leg pain
- Swelling at the ankles or calves
- Thickened skin
- Skin discoloration – dark brown or yellow appearance
- Significant bleeding from a varicose vein
- Ulceration of the skin
Treatment Options
The initial treatment for painful varicose veins involves compression therapy. Typically, this requires wearing a stocking type garment (i.e. a compression sock). However, there are other compression options available. Compression garments help reduce the swelling and dilation of the blood vessels by pressing on the vein. Leg elevation, weight loss and avoidance of prolonged sitting or standing are also important factors in treatment.
Depending on the success of compression therapy and your body’s reaction, a procedure might be in store.
- ClosureFast Procedure: ClosureFast™ is an alternative treatment option to traditional vein stripping surgery. Using ultrasound, your physician will position the closure catheter into the diseased vein through a small opening in the skin. The tiny catheter delivers radiofrequency (RF) energy to the vein wall. As the RF energy is delivered and the catheter is withdrawn, the vein wall is heated, causing the collagen in the wall to shrink and the vein to close. Once the diseased vein is closed, blood is re-routed to other healthy veins. This treatment option allows you to resume normal activity within a day with minimal to no scaring, bruising or swelling.
- Ambulatory Phlecectomy: Medium-sized and larger varicose veins can be removed by a procedure called stab avulsion or phlebectomy. This procedure can be performed using local anesthesia. Small incisions are made in the skin to allow a tool to be placed through the skin to hook the vein and pull it out through the skin incision. Once the leg has completely healed, incision scars are almost undetectable.
- Sclerotherapy: Sclerotherapy is a non-surgical treatment for varicose veins that involves injecting a detergent-like solution into the vein, causing the lining of the vein wall to swell, stick together and ultimately seal shut. Once the vein is sealed, the flow of blood is stopped and scar tissue develops in the vein. With the diseased vein sealed, blood is forced into healthier veins. The treated vein is absorbed and eventually becomes nearly invisible. Sclerotherapy may need to be performed multiple times over the course of weeks or months to achieve the desired results.
- VenaSeal: The VenaSeal procedure delivers a small amount of a specially formulated medical adhesive to the diseased vein. The adhesive seals the diseased vein and the blood is rerouted through nearby healthy veins. This new method does not require anesthesia along the course of the vein, which is known to cause discomfort.
If you are experiencing any vein problems or discomfort, please call the Vein Clinic for a free consultation at (541) 706-6505. To learn more visit www.smgoregon.com and click on the “Vein Clinic” tab under the “Specialties & Services drop down.
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It would seem that Maltese taxation is quite severe and the corporate income tax rate does not suggest that Malta is a low tax jurisdiction. However, this is not the case. The fact is that non-resident companies in Malta are entitled to a refund of taxes paid, which allows us to talk about the lower level of taxation in Malta compared to most countries in the world.
In order to claim a corporate income tax refund, a foreign company must be registered in Malta as a trading or holding company (deriving its income from trading activities or from participation in other organisations, respectively).
In the tax accounting of a Maltese company, the income earned by it must be recorded in one of four tax accounts: “foreign profits”, “Maltese profits”, “profits from immovable property”, “non-taxable income”. Each type of income is taxed according to its own rules. The final amount of tax is recorded in the fifth account “final tax”.
Example. Consider the two most common cases: a Maltese company derives profits from trading activities abroad and from participation in other companies. In either case, these profits are subject to statutory tax at 35 per cent, but the Maltese shareholders are entitled to claim a refund of the tax taken from the dividends distributed. The refund rules differ for different types of income.
If a Maltese company derives income from trading activities outside Malta (and the term “trading” includes both the direct purchase and sale of goods and the provision of services), its shareholders are entitled, upon receipt of the dividend, to apply for a refund of 6/7th of the tax previously paid in Malta. Therefore, the effective income tax rate will be 5 per cent.
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