Explain in anatomic terms why penetrating injuries to the inferior vena cava are commonly fatal. Explain how it is possible to ligate the inferior vena cava below the level of the renal veins without adverse effects.

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The Answer is Penetrating injuries of the upper part of the inferior vena cava are commonly fatal because (a) the site of the injury is inaccessible behind the liver, duodenum, and the mesentery of the small intestine; (b) the presence of the right costal margin makes surgical access difficult; (c) the thin walls of the vena cava are likely to tear extensively and make repair difficult; and (d) the almost certain possibility that the liver is also damaged.
The extensive anastomosis of the lumbar veins with other retroperitoneal veins ensures that the blood is able to bypass the obstruction should the inferior vena cava be ligated below the level of the renal veins (see CD Fig. 8-3).

Explain in Anatomic Terms Why Penetrating Injuries to the Inferior