The inferior vena cava commences at L5 by the junction of the common iliac veins behind the right common iliac artery (unlike the usual arrangement of a vein being superficial to its corresponding artery). It lies to the right of the aorta as it ascends until separated from it by the right crus of the diaphragm when the aorta pierces this muscle. The inferior vena cava itself passes through the diaphragm at T8 (Fig. 11), traverses the pericardium and drains into the right atrium.
As the inferior vena cava ascends, it is related anteriorly to coils of small intestine, the third part of the duodenum, the head of the pancreas with the common bile duct, and the first part of duodenum. It then passes behind the foramen of Winslow, in front of which lies the portal vein, separating it from the common bile duct and hepatic artery. Finally, the inferior vena cava lies in a deep groove in the liver before piercing the diaphragm. Within the liver it receives the right and left hepatic veins. Occasionally these veins fuse into a single trunk which opens directly into the inferior vena cava; on other occasions the central hepatic vein (which usually enters the left hepatic near its termination) drains directly into the inferior vena cava (Fig. 74). These variations are now of importance because of the possibility of carrying out resection of one or other lobe of the liver.
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