Inferior Vena Cava

A large, retroperitoneal vein returning deoxygenated blood from the lower and middle body to the right atrium of the heart. It is a thin-walled, valveless vein that has the largest diameter of the venous system.

Origin

Formed by the confluence of the left and right common iliac veins at L5, posterior to the origin of the right common iliac artery.

Course

• From its origin in the retroperitoneal cavity, it ascends anterolateral to the vertebral column and to the right of the aorta to T12, where it is separated from the aorta by the right crus of the diaphragm
• IVC pierces the central tendon of the diaphragm at vena caval hiatus T8, occasionally associated with the right phrenic nerve
• It then passes through the pericardium and entering the posteroinferior aspect of the right atrium.

Tributaries

• T8: paired inferior phrenic veins
• T8: left, right and middle hepatic veins
• L1: right suprarenal vein
• L1: paired renal veins
• L2: right gonadal vein
• L1-L5: lumbar veins
• L5: common iliac veins

The left suprarenal and gonadal vein drains into the left renal vein. The left suprarenal vein sometimes drains into the left inferior phrenic vein.

Relations

Anterior

• Right common iliac artery
• Right gonadal vessels
• Duodenum (D3)
• Common bile duct
• Portal vein
• Head of the pancreas
• First part of duodenum (D1)
• Epiploic foramen
• Liver

Posterior

• Lower lumbar vertebrae and intervertebral discs
• Anterior longitudinal ligament
• Right psoas major
• Sympathetic trunk
• Right coeliac ganglion
• Right 3rd and 4th lumbar arteries
• Right renal artery and right suprarenal artery, right inferior phrenic arteries
• Azygous vein

Lateral (left)

• Abdominal aorta
• Caudate lobe of the liver
• Right crus

Lateral (right)

• Liver
• Duodenum (D2)
• Right kidney and ureter
• Right testicular vein

Development

Inferior vena cava arises embryologically by complex series of fusion of primitive veins

Variant anatomy

• Absence of inferior vena cava (entire or only the infrarenal segment)
• Inferior vena cava duplication
• Azygous continuation of the inferior vena cava
• Persistent left-sided inferior vena cava – may join left renal vein
• Circumcaval ureter
• Circumaortic venous collar/left renal vein
• Inferior vena cava webs
• Extrahepatic portocaval shunt (Abernethy malformation)
• Marsupial cava
• Preaortic inferior vena cava/iliac vein confluence

Rarely a Eustachian valve at the inferior cavoatrial junction may be present.