What vascular anatomy understanding is needed to place an inferior vena cava (IVC) filter?

Updated: Oct 31, 2020
  • Author: Gary P Siskin, MD; Chief Editor: Kyung J Cho, MD, FACR, FSIR  more...
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Answer

Answer

The IVC is the largest venous structure in the body. It drains the venous return from the lower extremities, pelvis, and abdomen into the right atrium. The IVC originates at the L4-5 vertebral level and is formed by the confluence of the left and right common iliac veins. At this level, the IVC is posterior to the origin of the right common iliac artery. As it ascends to the right of the aorta and anterior to the spine retroperitoneally, the IVC receives blood from the lower lumbar veins and ascending lumbar vein.

The right gonadal vein and suprarenal veins empty directly into the IVC below and above the right renal vein, respectively. The counterparts of these veins on the left side drain into the IVC via the left renal vein. The renal veins join the IVC at vertebral level L1-2. The right renal vein has a shorter course and is typically situated more caudally. The left renal vein is longer and typically crosses in front of the aorta. At the level of the renal veins, the IVC lies posterior to the head of the pancreas. Then, it ascends in a groove posterior to the liver. The IVC receives the left, middle, and right hepatic veins, and often a separate branch from the caudate lobe, before it passes behind the right crus of the diaphragm to enter the right atrium (see the image below).

Anteroposterior image from an inferior venacavogra Anteroposterior image from an inferior venacavographic examination demonstrates an inferior vena cava of normal diameter without thrombus. In addition, the inflow from the renal veins can be seen at the level of the L1 vertebral body.

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