The problem of radiation-induced lesions is becoming increasingly urgent. Studies in recent years show that one of the most vulnerable  tissues is the endothelium when exposed to high doses of ionizing  radiation. The study of the pathogenetic bases of this phenomenon has  shown that damage to endotheliocytes occurs both at the expense of  the direct exposure to radiation and due to the systemic disturbance of  homeostasis which leads to the disadaptation of the executive and  regulatory systems of the organism. In this review we considered the  mechanisms of the development of endothelial dysfunction under the influence of radioactive radiation and possible methods of pharmacological correction of this condition.