According to contemporary conception, severe chronic venous insufficiency (CVI) is considered to be in patients in CEAP classes C4, C5 and C6, other words, in patients with trophic skin changes: pigmentation, venous eczema, lipo-dermatosclerosis, healed and active ulceration. Treatment of severe CVI is an important problem of angiology and vascular surgery, first of all because of high prevalence and incapacitating nature of CVI and on the other hand due to the difficult choice of optimal method of its management. Surgery allows eliminating of basic pathogenic mechanisms of development of severe CVI - truncal saphenous and perforating veins refluxes. According to recent medical studies, quitting of pathological blood flotation through incompetent perforating veins is the most important component of successful surgical treatment of severe CVI (1, 2). At the same time, carrying-out of surgical manipulation close to leg venous ulcer is associated with considerable alteration of pathologically changed tissues and high rate of postoperative necrotic and suppurative wound complications. Introduced in clinical practice in the middle eighties, Subfascial Endoscopic Perforator Surgery (SEPS) is a foolproof method of treatment of perforating veins reflux without direct surgical manipulation in the area of trophic disturbances (3). In this paper, we present initial case series, consisted of 5 patients with severe CVI, SEPS being used in complex treatment.