 Dr. Sanjeev Sangal, Professor Department Chair, welcome to our section of the Postural Epiderminal Wall. We have removed all the structures in the abdomen. This is the right side of the patient and this is the left side of the patient. That is the head end of the patient. Now let's come to pasticular structures that we can see in the Postural Epiderminal Wall. This is the infirvina keva. And we have cut it here at the point where it was entering the liver because the liver has been removed and we can see inside. We can see that the vein is very thin and it is filled with clotted blood. The extent of the infirvina keva is from E8 to L5 and we can see this is the opening of the infirvina keva in the diaphragm. It has been removed in the segment where it was inside the liver because the liver has been removed. However, having mentioned that this is the full extent of the infirvina keva we can see only a small portion of it and that is this much. Once it enters the liver, once it is inside the diaphragm, once it exits the diaphragm, it immediately enters into the right atrium so therefore we cannot see the infirvina keva thereafter. We can see the infirvina keva only from here to here. The infirvina keva actual length is longer than the aorta which is on the left. The aorta extends from the aortic hiatus. This is the aortic hiatus. This is the level of T12 and it bifurcates at the level of L4. So the abdominal extent of the aorta is less than the abdominal extent of the infirvina keva. However, we can see the full length of the aorta. I just mentioned a few important branches which are coming out from the aorta which you can see here. We can see the first branch which is coming out. This is the cut portion of the celiac trunk. This is the superior mesentery. The celiac trunk is the level of T12, superior mesentery is the level of L1 and this is the inferior mesentery which is the level of L3. We can also see the renal artery is coming out. The right and the left renal artery. These are at the level of, again around just below the superior mesentery artery. At this juncture we can mention that the superior mesentery artery goes in front of the left renal vein and here it can potentially produce compression of the left renal vein what is known as the nutcracker syndrome or the left renal vein entrapment syndrome. In this situation, the left renal vein as we can see it receives the left gonadal vein and in the case of males, this will be the left testicular vein and by compression of the left renal vein it can also produce compression of the left testicular vein and can produce varicosein of the left testis. Now let's open the aorta. So we have split open the aorta and we shall open it a little further approximately and you hear the sound. You can hear a clicking sound and I'm going to open it a little further distally also till the bifurcation there and we can see that because she is an elderly lady there is extensive calcification of the media of the aorta and we can feel it also. So this is Mochiburg's medial calcific sclerosis. This is the place where aorta usually gets calcified and it also can undergo atherosclerotic aneurysm and atherosclerosis. That brings me to the next part of the clinical correlation here. Abdominal aortic aneurysm is not very uncommon and it usually extends from the bifurcation of the renal arteries which is at the level of L1 to the bifurcation of the abdominal aorta into the two common alia arteries. If it is more than 6 centimeters under imaging studies then it's got a very high chance of rupture and the abdominal aortic aneurysm when it occupies this place we will see that the inframacentric artery the opening of which can be seen here the inframacentric artery arises from the apex of the aneurysm and in such situations we can often see and feel the pulsation through the anti-abdominal wall. This is the place where the abdominal aorta bifurcates into the middle of L4. In thin walled individuals we can even feel the pulsation of a normal abdominal aorta. Abdominal aorta is used as a very common useful root for angiograms and for that we can cannulate the femoral artery which we can see here. Femoral artery passes through the inguinal canal at the mid-inguinal triangle and it's in the femoral triangle and we can feel the pulsation of the femoral artery we can cannulate it from here we can pass the cannula up the external alia artery then it goes up the common alia arteries and then we can pass it into the abdominal aorta and from there whichever vessel we want to do angiogram whether it's the inframacentric, whether it's the supramacentric the celiac or the renal we can do angiogram. We can even pass it further up and do an artogram or even a coronary angiogram and this picture shows an artogram. In a similar way we know that in the femoral triangle the femoral vein is immediately medial to the femoral artery so we can palpate the femoral artery and we can cannulate the femoral vein medial to that and we can pass the cannula through the same root and we can go to the inferior vena cava and from there we can go to the right heart and we can do a cardiac catheterization. Now let's take a look at some other vessels. We can see this vessel here which I had already alluded to earlier this is the left gonadal vessel the gonadal vein opens into the left renal vein while the gonadal artery comes out from the abdominal aorta directly at the level of L2 this is the right gonadal vein the right gonadal vein drains directly into the inferior vena cava while the right gonadal artery comes out from the abdominal aorta again at the level of L2 Now let's take a look at some of the vessels when we retract the abdominal aorta and we can see these vessels coming out these are the lumbar arteries accompanying them we have the lumbar veins and we can also see some of these lymph nodes which are present on either side these are the L2 cava lymph nodes also known as the lumbar lymph nodes these lumbar arteries they are the ones which supply the posterior abdominal wall accompanying them we have the lumbar veins the lumbar veins on the right side they all unite and they form what is known as the beginning of the azygous vein and we can see the azygous vein here and this is the opening of the azygous vein and the azygous vein then passes through the aortic hiatus and it goes into the thorax and there it becomes larger and it becomes the azygous vein which runs in the posterior mediastanum and opens into the superior vena cava this constitutes an important anastomosis between the inferior vena cava and the superior vena cava on the left side we have the hemiazygous which is also formed in a similar way but it is smaller and this also climbs up it goes through the diaphragm on the left side and then it curves to the right side and opens into the azygous vein in the thorax so this is the azygous hemiazygous system which forms an important communication between the inferior vena cava and the superior vena cava system now let's take a look at this structure here in the region of the celiac trunk this is the big cisterna caili the cisterna caili is a sac which is filled with lim kail and it is formed by union of the lumbar lymphatic trunks the industrial lymphatic trunks the lower thoracic and the lower intercostal lymphatics coming from above so all of these they unite and they form a sac which is known as the cisterna caili and from there a duct comes out which is known as the thoracic duct and this thoracic duct also passes through the aortic hiatus and it climbs up into the thorax and then it opens into the left venous angle so the azygous vein the thoracic duct and the aorta all three of them enter the thorax through the aortic hiatus and they are in that order from right to left that's all for now thank you very much for watching if you have any questions or comments please put them in the comment section below have a nice day Dr. Sanjay Sanyal signing out please don't forget to like and subscribe this video channel thank you very much