Dibirov M.D., Vinokurov V.G., Gadzhimuradov R.U., Evseev Yu.N., Novosel'tsev O.S., Tipikin I.S., Dibirov A.A. Moscow. Treatment of patients with occlusive diseases of the lower extremity vessels in the elderly and senile population is one of the most challenging surgical tasks. Atherosclerotic arterial disease is one of the main causes of death in this age group. Performing reconstructive surgeries in this manner is associated with significant risk, and in 25-40% of patients, the intervention is impossible due to the widespread nature of the occlusive process. One method of influencing collateral circulation is surgical intervention on the sympathetic nervous system. The introduction of minimally invasive videoendoscopic surgeries has significantly expanded the indications for lumbar sympathectomy and allowed it to be performed in patients with extremely complicated comorbidities. A total of 95 pure lumbar sympathectomies were performed in elderly and senile individuals with chronic arterial insufficiency using minimally invasive techniques and videoendoscopic equipment and instruments. The control group consisted of 39 patients with a similar clinical picture who underwent lumbar sympathectomy through a standard lumbotomy approach according to Takats. Other approaches were not used. Indications for sympathectomy were: the impossibility of performing reconstructive surgeries due to multi-stage localization of the stenotic-occlusive process, poor distal outflow. Lumbar sympathectomy was performed mainly at stage III ischemia (69%), both in obliterating atherosclerosis and diabetic microangiopathy. At stage IIB ischemia, indications for lumbar sympathectomy (24%) were the lack of significant improvement in limb blood supply after prolonged and repeated conservative therapy. In patients with stage IV ischemia, the indication for sympathectomy was the impossibility of performing reconstructive surgery due to a vascular factor (87%). Of the nine patients with stage IV disease, six had trophic ulcers up to 4-6 cm. Three had dry, localized gangrene without a pronounced perifocal inflammatory-necrotic process. To clarify the indications for sympathectomy in distal occlusions, a test with intra-arterial administration of Mydocalm (No-shpa) was used. The following diagnostic methods were used during the examination: skin thermometry, rheovasography, radioisotope study of cutaneous and muscle blood flow, Doppler ultrasound, duplex scanning of blood vessels, angiography, laboratory tests, and standard general clinical diagnostic methods. Of the 95 patients operated on, 10 (10.5%) had no effect from sympathectomy, and 8 of them underwent femoral amputation. Good results were noted in 16 (16.9%) patients, with some improvement observed in 69 (72.6%). Analysis of complications after sympathectomy in the study and control groups showed that, despite the severity of their condition, patients in the study group experienced three times fewer complications than those in the control group. With proper patient selection, lumbar sympathectomy can not only improve the patient's condition and relieve pain, but also heal trophic ulcers. In some patients, it can even perform minor amputations and achieve independence from their loved ones. Minimally invasive sympathectomy techniques allow for a twofold expansion of the indications for surgery in severely ill patients, and if there are no contraindications to general anesthesia or epidural anesthesia, there are no surgical contraindications to this type of intervention.