M.V. Melnikov, V.V. Dudarev. Objective: To evaluate the effectiveness of endoscopic perforator vein dissection in patients with varicose veins complicated by stage 2-3 chronic venous insufficiency. Endoscopic subfascial perforator vein dissection (ESPVD) was used in 16 patients. The average age of the patients, with a 2:1 ratio of women, was 32+/-0.5 years. The patient's medical history ranged from 3 to 15 years. Trophic disorders were localized in the lower and middle thirds of the leg and were characterized by hyperpigmentation, induration of the skin and underlying tissue, and long-term non-healing active ulcers. Preoperative examination of the patients included triplex scanning of the venous systems of the lower extremities to determine the functional integrity of the valve apparatus of the great vessels, their patency, the presence of thrombi, and mapping of incompetent perforating veins. The surgeries were performed under epidural anesthesia using videoendosurgical equipment and instruments (Kazan). Two 10-mm trocars for the endoscope and dissector were inserted into the subfascial space of the leg. The skin incision was no more than 1.0-1.5 cm, and the fasciotomy was 0.5 cm. The working cavity was created by insufflating carbon dioxide at 8-10 mmHg. After identifying incompetent perforating veins, they were dissected. Vessels up to 5 mm in diameter were divided with an L-shaped thermodissector, while veins larger than 5 mm in diameter were pre-coagulated with a bipolar electrode or clipped and then divided. At the final stage, the fascia was not sutured, and subfascial drainage was not performed. After the endoscopic stage, combined phlebectomy of the subcutaneous veins, as adopted in the clinic, was performed. A compression bandage was applied after the surgery. The postoperative period ranged from 5 to 7 days. Results: minimal trauma to the "compromised" soft tissues of the leg during ESPV allowed for surgery on active venous ulcers and avoided purulent complications. In the immediate postoperative period, early patient mobilization was possible, and the healing and epithelialization time of active ulcers was reduced to an average of 2-4 weeks. In 4 patients (25%), swelling in the ankle joints and lower leg, which was absent preoperatively, persisted during the first 7 days after surgery. Based on the system for assessing the long-term results of surgical treatment for complicated varicose veins proposed by G. Hauer (1999), the use of videoendosurgical technology allowed us to achieve excellent results in 74% of patients. There was no recurrence of the disease. Conclusions: ESPV is an effective method for surgical treatment of varicose veins of the lower extremities at the stage of trophic complications. It eliminates the shortcomings of the traditional Linton procedure and expands the indications for surgical treatment in this category of patients.