 This is a demonstration of the inferior vena keva after we have removed all the abdominal organs. We have already described the aorta in a previous section, now we are going to describe the inferior vena keva. So, inferior vena keva is located to the right of the aorta and we can see this the inferior vena keva. The extent of the inferior vena keva is from the cable hiatus in the diaphragm which is on the right side of the central tendon at the level of T8 and it ends where the inferior vena keva bifurcates into the two common eye at the level of L5. So, this is the full length. However, we notice that this portion of the inferior vena keva is missing because this was the portion which was inside the liver intra hepatic portion and therefore, when we remove the liver it that we removed inferior vena keva in the abdomen is longer than the aorta which is on the left side. However, we can see only this segment of it because the intra hepatic portion the intra diaphragmatic portion and thereafter immediately it enters into the right atrium of the heart. Therefore, we cannot see after it enters the liver. So, therefore, this is the only portion of the inferior vena keva that we can see. Coming to the tributaries of the inferior vena keva. By and large most of the tributaries of the inferior vena keva match that of the anches of the aorta. However, there are certain differences. Let us take a look at some of the important tributaries here. We can see this cut portion here. This is the cut portion of the right testicular vein or the gonadal vein in the case of female it will be the right ovarian vein. On the left side we notice that there is no testicular vein opening into the inferior vena keva. Instead the testicular vein is opening into the left renal vein. So, that is one important point about the tributaries. The next thing that we notice is about the renal veins themselves. This is the left renal vein. This is the kidney. We have cut the renal vein here and this is the right renal vein. We notice several things. First of all we notice that the renal veins are located anterior to the corresponding renal arteries. In this case the patient has got two renal arteries on the left side and one on the right side. But in any case the renal vein is anterior that is to prevent compression of the renal vein by the thick wall arteries. The next thing we notice is that the left renal vein is considerably wronger than the right renal vein because obvious reasons the inferior vena keva is located on the right side. But more important than that we notice that the left renal vein not only receives the left testicular vein or the gonadal vein as we can see here it also receives the left supra renal vein. The left supra renal vein drains into the left renal vein and we can see it here. On the other hand on the right side the right supra renal vein drains directly into the inferior vena keva and we can see the opening of that here. This is the opening where it goes draining from the right supra renal vein. I would like to draw your attention to these veins which are draining on either side and when I retract the inferior vena keva we can see these veins. This is on this side and when I retract it like this we can see the veins on this side also. These are the lumbar veins. They closely match the lumbar arteries which accompany them. So there are four or five of these. The point to be noted is look at the lumbar vein on the the first one. It's considerably large and here also we see that the lumbar vein on the top is considerably large on the left side. These lumbar veins they unite and as they unite not only do they drain into the inferior vena keva they also unite and on the right side they mark the beginning of the formation of the azygous vein and we can see that the beginning of the formation of the azygous vein is here. On the left side they also you communicate with each other and they drain into the inferior vena keva under the power tab. They also communicate with the left renal vein and on the left side also these lumbar veins they unite and they form as they go up they become known as the hemi azygous vein. So the head azygous vein on the right side and the hemi azygous vein on the left side they constitute drainage of the posterior abdominal wall and they travel through the diaphragm and they go and open into the superior vena keva. The hemi azygous vein crosses over at the level of T8 in the thorax and joins the azygous vein. So these hemi azygous, azygous and hemi azygous system constitutes an important site of communication between the inferior vena keva and the superior vena keva. So when there is an inferior vena keva compression they drain the blood directly to the superior vena keva. Coming to a few clinical correlations pertaining to the inferior vena keva. The inferior vena keva is used as a route for cardiac catheterization. We can calculate the femoral vein in the thigh because we know that the femoral vein is located medial to the femoral artery. We can palpate the femoral artery pulsation and just medial to that we can cannibalate it and we can pass the cannula through the external iliac, common iliac vein and into the inferior vena keva. We can do it on either side and once we do that we can push the cannula up and it will go into the right atrium of the heart. So that is a route for cardiac catheterization. Since we are already on the topic we can use the same route using the femoral artery instead of the vein to do catheterization of the external iliac artery, common iliac artery and the abdominal aorta and we can use that route to do what is known as aerotogram or angiogram of any one of the branches of the aorta namely the inferior mesentrics, superior mesentry, celiac trunk or even the renal arteries. So this is an angiogram of the right kidney to show the renal artery and the five segmented renal arteries. Rarely we can have some congenital abnormalities. We can have what is known as the left sided inferior vena keva which is not very common. We can have yet another condition where the right ureter which is normally descending down like this it can be retro cable it can go behind the inferior vena keva and that is referred to as a retro cable ureter in which case it is a potential site of constriction of the right ureter. Coming to a few important clinical correlations pertaining to this tributary on the left side that is the left renal vein. This left renal vein is a potential site of compression by this artery here. This is the superior mesentry artery which runs just on top of the left renal vein. So the left renal vein can be compressed between the superior mesentry artery in front and the aorta behind and that is referred to as the left renal vein entrapment syndrome and it is also called the nutcracker syndrome though there are many other venaceous of the nutcracker syndrome. When the left renal vein is compressed it can indirectly even compress the left testicular vein and can lead to varicosein of the left testis in the vein that is another clinical correlation. Yet another important clinical correlation pertaining to the left renal vein is because it is the longest one compared to the right side and the screen has been removed but the splenic vein runs in the splenorenal ligament very close to the left renal vein. It is running close here and therefore the splenorenal shunt which is a surgical communication between the splenic vein and the left renal vein is to decompress the portal vein in cirrhosis with portal hypertension. Incidentally this patient did have cirrhosis with portal hypertension. So that is another important clinical correlation pertaining to the left renal vein. So that is all for now. If there are any questions or comments please put them in the comment section below Dr. Sanjeev Sanyal Sanyal. Thank you for watching.