BACKGROUND: Chronic total occlusion of the coronary arteries can be found as a finding in coronary angiography following a nonreperfused myocardial infarction of more than 3 months of evolution, in patients with chronic angina or as an incidental finding in the diagnostic coronariography, in which the territory myocardium of the affected vessel may present cell death. OBJECTIVE: To compare if the presence of venous return in the territory of the artery with chronic total obstruction is an angiographic parameter validated to evaluate an adequate myocardial perfusión against those who did not present it. MATERIALS AND METHODS: An observational, ambispective study, consisting of the review of cases of patients who underwent. We reviewed the coronary angiography cases performed at the Hemodynamic Service of the Central Military Hospital from April 2015 to October 2016 and collected cases in which chronic total occlusion of the anterior descending, with and without presence of venous return, after which cardiac gammagram was performed to assess perfusion in that territory. RESULTS: In patients with left anterior descending coronary artery with chronic total occlusion and venous return, 90% (n=19) had myocardial perfusion and 81% (n=17) presented some degree of myocardial ischemia, whereas in patients with chronic total occlusion without venous return, 75% (n=9) had no myocardial perfusion and 25% (n=3) presented some degree of myocardial ischemia (p< 0.01). CONCLUSIONS: Venous return may be a valid angiographic indicator to predict adequate myocardial perfusion in the area of total occlusion of the anterior descending artery.