Level of Bifurcation of Aorta and Iliocaval Confluence and Its Clinical Relevance

Purpose: The best approach to the body of the lumbar vertebrae is from the anterior aspect. The lower lumbar vertebrae are more prone to mechanical and degenerative changes. The disadvantage is that the front of the lower lumbar vertebrae are related intimately to important neurovascular structures like the abdominal aorta, inferior venacava, sympathetic chain etc. There is a need for the preoperative evaluation of the vascular structures related to the lumbar vertebrae. Methods: The abdominal cavity of the cadavers were opened, the intra abdominal structures were retracted to expose the posterior abdominal wall. The structures related to the anterior aspect of the lumbar vertebrae were dissected and cleaned to expose the great vessels, the Abdominal Aorta and the Inferior Vena cava. The sacral promontory was identified and the level of the bifurcation of the AA and IVC formation were identified with respect to the lumbar vertebrae. Variations were also looked for. Results: The bifurcation of Aorta was seen at the body of L4 (55%) and L3 (27.5%). The IVC formation was seen on the body of L5 and L5-S1 spine. The IVC was more prone to variation when compared to AA. The variation observed with IVC was mainly in the form of multiple unnamed tributaries draining into the IVC. The variation observed in the abdominal aorta was high level of bifurcation at L3 body which is unusual. Conclusion: Preoperative evaluation of the vascular anatomy of the lower lumbar vertebra is essential to avoid postoperative complications.