Retrograde intravenous perfusion (RIP), so-called Bier's blockade is a relatively new method of treatment of critical ischaemia of the extremities. It is based on the principle of retrograde, i.e. transvenous perfusion of the capillary circulation during which at the time of artificially discontinued circulation in the extremities a high concentration of effective substances in the target tissues is achieved. In addition to the mentioned critical ischaemia Bier's blockade can be successfully used in the treatment of so-called "diabetic foot". It is also possible to implement by this method a local medicamentously induced block of the sympathetic nerves by administration of Guanethidine. In patients with contraindications of systemic fibrinolytic treatment local thrombolysis can be made in phlebothromboses and acral vascular occlusions. In the treatment of tumours on the extremities, e.g. melanoblastome, it is possible to achieve by local administration of cytostatics comparable results, while the incidence of undesirable effects is smaller. The objective of the present work was to make the professional public familiar with this method. On the example of four patients with trophic defects of the lower extremities which developed as a result of primary thrombocythemia the application of Bier's method was demonstrated.