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Both kidneys have similar muscular surroundings. Posteriorly, the diaphragm covers the upper third of each kidney. Medially, the lower two-thirds of the kidney lie against the psoas muscle, and laterally, the quadratus lumborum.
The right kidney borders the duodenum medially. Its lower pole lies behind the hepatic flexure of the colon.
The left kidney is bordered superiorly by the tail of the pancreas, the spleen superolaterally, and the splenic flexure of the colon inferiorly.
The Gerota’s fascia encloses the kidney and is an effective barrier for containing blood or a urine leak.
The renal artery and vein travel from the aorta and IVC just below the SMA at the level of the second lumbar vertebra. The vein lies anterior to the artery. The renal pelvis and ureter are located posterior to the vessels.
The right renal artery takes off from the aorta with a downward slope under the IVC into the right kidney. The left renal artery courses directly off the aorta into the left kidney. Each renal artery branches into five segmental arteries as it approaches the kidney.
The right renal vein is typically 2–4 cm in length, does not receive any branches, and enters into the lateral edge of the IVC. Ligation of the vein causes hemorrhagic infarction of the kidney because of the lack of collaterals.
The left renal vein is typically 6–10 cm in length, passes posterior to the SMA and anterior to the aorta. The left renal vein receives branches from the left adrenal vein superiorly, lumbar veins posteriorly, and the left gonadal vein inferiorly. This allows for ligation of the left renal vein close to the IVC.
Above and below the knee amputations require basic anatomy knowledge of the muscle compartments, nerves, and arteries of the lower extremity.
The thigh has three compartments: anterior, posterior, and medial. The calf has four compartments: the anterior, lateral, or peroneal in addition to the deep and superficial posterior ones.
The lower extremity is perfused by the superficial and deep femoral artery. The superficial femoral artery continues as the popliteal artery after exiting the Hunter’s canal. The popliteal artery bifurcates into tibialis anterior artery and the tibioperoneal trunk. The tibioperoneal trunk gives the fibular artery and continues as the posterior tibial artery. The femoral and sciatic nerves provide innervation to the lower extremity.
The upper mediastinum contains the aortic arch with the origins of its major branches. These include the innominate (brachiocephalic) artery, proximal left common carotid artery, and proximal left subclavian artery. The left and right innominate (brachiocephalic) veins join to become the superior vena cava (SVC).
The thymic remnant and surrounding mediastinal fat are the first tissues encountered when entering the upper mediastinum. These tissues lie over the left innominate vein and the aortic arch.
The left innominate vein is approximately 6–7 cm long and it transverses the upper mediastinum under the manubrium sterni and over the superior border of the aortic arch. It joins the right innominate vein just to the right of the sternum at the level of the first to second intercostal space to form the SVC.
The right innominate vein is approximately 3 cm in length and it courses vertically downward and joins the left innominate vein at a 90° angle to form the SVC.
The SVC is approximately 6–7 cm in length and is located lateral and parallel to the ascending aorta. A small segment is enclosed within the pericardium.
The ascending aorta is contained within the pericardium. The aortic arch begins at the superior attachment of the pericardium. The first branch of the aortic arch is the innominate artery, which then branches into the right subclavian and right common carotid arteries. The next branch of the arch is the left common carotid artery, followed by the left subclavian artery. The innominate artery and the left common carotid artery originate relatively anteriorly, while the left subclavian artery originates more posteriorly. Anatomical variants include a common origin for the left common carotid artery and innominate artery, as well as a common origin for the left subclavian and left common carotid artery.
The left vagus nerve travels between the left common carotid and subclavian arteries just anterior to the arch and branches off into the recurrent laryngeal nerve, which loops around and behind the aortic arch, ascending along the tracheoesophageal groove.
The right vagus nerve crosses over the right subclavian artery, immediately gives off the recurrent laryngeal nerve, which loops behind the subclavian artery and ascends behind the common carotid artery along the tracheoesophageal groove.
The thoracic or descending aorta begins at the fourth thoracic vertebra on the left side of the vertebral column. Below the root of the lung, it courses to a position anterior to the vertebral column as it passes into the abdominal cavity through the aortic hiatus in the diaphragm at the twelfth thoracic vertebra.
The esophagus lies on the right side of the aorta proximally. Distally, as it enters the diaphragm, it courses in front of the aorta.
The aorta has nine pairs of aortic intercostal arteries that arise from the posterior aspect of the aorta and travel to the associated intercostal spaces. The bronchial and esophageal arteries are additional branches of the aorta as it descends in the thorax.