Modern surgery of varicose veins depends on a differentiated diagnostics. The planning and the type of operation have to take the particular hemodynamics into consideration. The main prerequisites are early operation to prevent secondary popliteal and femoral vein insufficiency and, on the other hand, a restrained tissue-sparing technique in order to preserve transplantable vein segments. Paratibial fasciotomy is a low-risk and technically uncomplicated method for the treatment of severe chronic venous congestion.