Videoendoscopic interventions have now become an integral part of the treatment of many conditions, including venous ones. This approach fully reflects current trends in global medical science and practice, which emphasize selective, precisely measured interventions on damaged structures of the body without damaging healthy tissue. The use of a wide variety of visualization methods and specialized instruments allows for interventions to be performed through a small incision, significantly reducing invasiveness and the risk of postoperative complications. In patients with complicated forms of varicose veins, venectomy is performed in combination with endoscopic dissection of communicating veins. A critical step in the treatment of patients with varicose veins complicated by trophic disorders is the ligation and transection of incompetent perforating veins. The typical dissection of tissue from the knee to the ankle, as well as in areas of trophic disorders, in the Linton-Felder procedure is often complicated by postoperative wound suppuration. In addition, the cosmetic effect of the surgery leaves much to be desired. In recent years, operations using video endoscopic technology (endoscopic dissection of communicating veins) have been widely used in patients with varicose veins of the lower extremities complicated by trophic disorders of the lower leg. Video endoscopic operations can significantly reduce the incidence of postoperative complications and the trauma of intervention in severe forms of venous insufficiency, and reduce the duration of hospitalization and rehabilitation. Indications for endoscopic dissection of perforating veins. Absolute: - varicose veins with severe trophic disorders of the skin: induration of subcutaneous fat, recurrent and open trophic ulcers; Relative: - concomitant lymphatic insufficiency; - uncomplicated varicose veins with multiperforating venous discharge; - surgical treatment of post-thrombotic disease complicated by trophic disorders. Endoscopic perforator vein dissection technique. A 3-cm skin incision is made 3-5 cm proximal to the trophic disorder zone. Depending on the location of the incompetent perforator veins in the leg, a medial or lateral approach is used. The proper fascia is incised, and a special tube with an endoscope connected to a monitor is inserted into the subfascial space. Further manipulations in the subfascial space are performed under video guidance. The endoscope is slowly advanced toward the incompetent perforator vein, carefully separating the tissue. Under endoscopic guidance, perforator veins are isolated using special instruments. Small (2-5 mm) veins are coagulated, and larger (over 5 mm) veins are clipped and transected with special scissors. Typically, 1 to 9 incompetent communicating veins are transected during the procedure. After completion of the endoscopic stage of the procedure, a standard combined venectomy is performed. Results of videoendoscopic surgery. In patients with severe trophic disorders of the lower leg, removal of the great saphenous vein in the affected area may be associated with serious complications. In such situations, varicose veins in the lower leg are surrounded by scar tissue. After vein removal, cavities with thinned skin remain in the sclerotic tissue. This can lead to the formation of retracted, deformed scars and severe pain. Therefore, crossectomy, femoral venectomy, and catheter obliteration of the great saphenous vein trunk in the lower leg are recommended for these patients. The use of endoscopic techniques has eliminated the need for large, disfiguring incisions in this patient population, reducing hospitalization and rehabilitation time, and significantly improving treatment outcomes. Patients are typically discharged 2-5 days after surgery. In the late period following this procedure, clinical manifestations of chronic venous insufficiency, such as induration, pigmentation, lipodermosclerosis, and dermatitis, are significantly reduced. Open trophic ulcers heal rapidly. Just a few months after videoendoscopic surgery, a significant reduction in skin hyperpigmentation in the lower third of the leg is noted, although it does not completely disappear. Endoscopic surgery significantly accelerates patient recovery, more than doubling that of traditional surgery. Thus, the use of this technique significantly simplifies the surgeon's work, minimizes the severity and risk of surgery, and improves the patient's condition in the postoperative period. All this demonstrates the undoubted potential of this surgical intervention, making it the procedure of choice for patients with varicose veins of the lower extremities complicated by trophic disorders.