The only vascular structure listed at vertebral level L3 is the inferior vena cava (IVC). The abdominal aorta is also present at this level, and would be of vital concern.
The IVC is formed at L4-L5 where the common iliac veins join together. This is below L1, where the renal arteries and veins are located. The IVC drains blood from the lower extremities, abdominal and pelvic viscera. It receives blood from the portal vein and enters into the right atrium of the heart.
Ladapo et al. characterize the effects (in terms of number of publications) of the 1996 Congressional appropriations bill prohibiting federal research funding for use in studies of firearms and injury prevention. The authors found that from 1991 to 2010, there were more than 300,000 deaths among youth from the 10 leading causes and more than 300,000 publications. However, while firearms accounted for 12.6% of deaths, there were only 25 publications on firearms in 1991, 61 in 1999, and 33 in 2009. This contrasts with publications on neoplasms, which while responsible for approximately the same number of deaths, increased from 5519 to 9707 over the same time frame.
Buckman et al. review injuries to the IVC. The authors note that injuries to the IVC are generally fatal regardless of injury mechanism. Individuals who present in shock and do not respond to initial resuscitation, who are still bleeding at the time of laparotomy, and those with injuries to the retrohepatic vena cava all result in a high rate of mortality. Death is most commonly caused by intraoperative exsanguination.
Illustration A depicts the anatomy of the superior vena cava, inferior vena cava, azygos vein, and their tributaries.
Answer 2: The common iliac artery branches into the internal iliac artery and external iliac artery at the pelvic brim, in front of the sacroiliac joints. The internal iliac artery travels down to the greater sciatic foramen where it divides into anterior and posterior branches.
Answer 3: The internal iliac vein begins near the greater sciatic foramen, courses upward along but slightly medial to the internal iliac artery, and joins with the external iliac vein to form the common iliac vein at the pelvic brim.
Answer 4: The left and right renal arteries branch off the aorta at L1.
Answer 5: The portal vein, formed by the union of the superior mesenteric vein and the splenic vein, is located in the right upper quadrant of the abdomen.
Ladapo JA, Rodwin BA, Ryan AM, Trasande L, Blustein J. Scientific publications on firearms in youth before and after Congressional action prohibiting federal research funding. JAMA. 2013 Aug 7;310(5):532-4. doi: 10.1001/jama.2013.119355. PubMed PMID: 23925624.
PMID:23925624 (Link to Abstract)
Buckman RF, Pathak AS, Badellino MM, Bradley KM. Injuries of the inferior vena cava. Surg Clin North Am. 2001 Dec;81(6):1431-47. Review. PubMed PMID: 11766184.
PMID:11766184 (Link to Abstract)