Aim — to evaluate the clinical efficiency and remote results of application of genetic engineering structures based on vascular endothelial growth factor VEGF165 («Neovasculgen») in complex treatment of patients with chronic lower limb ischemia. Material and methods. It was analyzed 41 patients who were treated at the Department of Vascular Surgery of B.V. Petrovskiy Russian Research Surgery Center for chronic lower limb ischemia Fountain Pokrovsky stages IIB—IV. All patients aged from 37 to 79 years with chronic lower limb ischemia Fountain Pokrovsky stages IIB—IV underwent complex treatment with the drug based on vascular endothelial growth factor VEGF165 «Neovasculgen». Atherosclerosis was observed in 38 patients, nonspecific arteritis — in 3 patients. Results. Trophic disorders of soft tissues of lower extremities were revealed in 3 cases. All patients included in this study had significant diffuse changes in lower limb arteries. Estimation of clinical efficiency established clear positive dynamics in all groups of patients. Thus, pain-free walking distance in the first group was 258±108 meters (p<0.0001), 11 of 26 patients switched from IIB to IIA stage of chronic lower limb ischemia. In the second group pain-free walking distance was 213±209 meters (p=0.01) and 7 and 3 of 15 patients switched from III to IIB and IIA stages respectively. The data obtained using muscle perfusion in 38 patients with radioisotope scanning performed before introduction of the «Neovasculgen» and in 6 months after that revealed augmentation of muscle perfusion by an average of 450±72% (p<0,05) and 490±94% (p<0,05) in the first and second groups respectively.