Elimination of incompetent perforating veins is the effective therapeutic method in the treatment of lower leg ulceration and trophic skin disorders associated with chronic venous insufficiency. The subfascial endoscopic ligation is a new surgical method to treat patients with incompetent perforating veins. 19 patients with severe chronic venous insufficiency or protracted venous ulceration of lower leg were treated. Through an incision of the skin the proximal 1/3 of the lower leg-far away from the dermatosclerotic area-an endoscope is inserted after which the perforating veins are ligated by clips under direct vision. The method is recommended due to its reduced invasiveness and the fair results.