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Major abdominal vascular. The management of penetrating abdominal trauma has evolved greatly over the last century. If any of the blood vessels in this area become blocked, surgery may be needed to repair them. Not infrequently, multiple concomitant vascular injuries, including arterial, can be encountered in addition to associated injuries to nonvascular viscera. Temporary vascular access can be obtained via intraosseous placement in 1 or both humeral heads. The impact of arterial, venous and Feb 16, 2024 · Abdominal arteries can range from small, inconsequential branches to major trunks that, when injured, can commonly determine whether life or death results after penetrating trauma. In a prospective study of vascular abdominal trauma caused by gunshot injuries in 217 patients who underwent Vascular entry injuries are the most feared complications of laparoscopic surgeries and frequently occur with the insertion of a Veress needle or trocar due to the proximity of major abdominal vessels and abdominal wall. Penetrating abdominal trauma typically involves the violation of the abdominal cavity by a gunshot wound (GSW) or stab wound. By visiting this site you agree to the foregoing See instructions for after Major Abdominal or Vascular Surgery. Injuries to major abdominal vessels are most com- This may tead toa cardiopulmonary arrest in transit monly encountered in u ban trauma centers where to the hospital or in the emergency center. Abdominal vascular trauma: Approach to hemorrhage at laparotomy. Most of them are life-treatening emergencies, sice they may cause an important ipovolemic shock or severe ischemia in their end organ and require prompt diagnosis and Oct 12, 2021 · This study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma based on a large registry of trauma patients. Others have emphasized that most deaths from major abdominal vascular injury are a result of hemorrhage. Thousands of new, high-quality pictures added every day. 17 Another review of single-center data from 1992–1997 showed These organs are your kidneys, liver, spleen, stomach, and bowel (intestines). The stomach Our pack includes: Tiburon® Laparotomy Drape 29410; 25 1/2" x 26" absorbent reinforcement; 4" x 12" fenestration with adhesive; instrument pad; gusseted armboard covers; cord-holding tabs (A29410N) Astound® scrub nurse gown with prewashed cloth towel in outer wrap, unreinforced, large (A90970N) Mayo stand cover, reinforced poly, 23"W (A8337CN) 10 lap sponges (CS001) Nonconductive suction Jun 29, 2022 · Atherosclerosis of the aorta is the gradual buildup of plaque in your largest artery. Identification of vascular injuries in the setting of blunt abdominal trauma can pose a diagnostic challenge, as detec-tion is reliant on appropriate multidetector computed tomography (CT Abdominal vasculature Discuss the abdominal aorta? The abdominal aorta begins at the aortic opening in the diaphragm (at about T12) and descends anterior to the vertebral bodies and ends at L4 by dividing into the right and left common iliac arteries. Efect of damage control surgery on major abdominal vascular trauma. Because anatomic location of major … Introduction Vascular calcification—pathological deposition of hydroxyapatite crystals can occur throughout the vascular system, including large arteries such as the aorta, carotids, and tibial arteries, as well as in smaller vessels such as coronary arteries and skin capillaries. Atherosclerotic lesions in the abdominal aorta or its major branches are often incidentally detected on abdominal CT. Injuries occur in five areas, each Introduction Abdominal vascular injuries are the most common cause of death after penetrating abdominal trauma. Dente and David V. In such centers 10% to 20% of all patients undergoing laparotomy have an injury to a major vessel, and 25% to 30% of all vascular injuries treated occur in the abdomen. D) Adult Blunt Splenic Trauma (Updated 2016) (1° author: Susan Rowell, M. Feb 4, 2022 · This includes patients undergoing abdominal or pelvic visceral resection, formation or reversal of stoma, open vascular surgery, anterior abdominal wall hernia repair, or transplant surgery. Vascular injuries are found in 10–20% of patients undergoing laparotomy for penetrating injury. Sorrentino TA, Moore EE, Wohlauer MV, Bifl WL, Pieracci FM, Johnson JL, et al. Aug 1, 2016 · Major abdominal vascular injuries are usually a result of penetrating trauma and associated with a high mortality rate. When major abdominal venous injuries are considered, the survival rate ranges from 50% to 95%. Vascular cases were identified using targeted database for open abdominal aortic aneurysm and open aortoiliac disease and general cases were identified using Current Procedural Terminology codes for Jan 6, 2022 · Abdominal arteries demonstrate extensive variability in their origins and course, along with variations in the form of common origins of multiple arteries, and accessory or additional arteries. ) Management of Pelvic Fracture with Hemodynamic Instability (2016 Updates) (1° author: Thai Lan Tran, M. 8 Inspection and Auscultation of Abdominal Vasculature **This is an advanced skill Inspection and auscultation of abdominal vasculature is best performed with the client in a supine position with their head on a pillow. May 4, 2024 · The anterolateral abdominal wall has an intricate vascular network. The identification of abdominal vessels using ultrasound is based on knowledge of their normal location, appearance and relationship to specific organs. Forty-four patients had more than one major vascular injury and 17 (39% recovered, compared to a survival rate of 76% with single vascular trauma. This study's purpose was to determine plasma VEGF levels before and early after major open and minimally invasive abdominal surgery. . ) Rib Fractures (1° author: Karen Brasel, M. However, clinical implications and optimal subsequent management are mostly left undetermined. Survival is dependent on early diagnosis and rapid intervention. Jul 20, 2016 · Introduction Abdominal vascular trauma is rare, lethal, and primarily associated with penetrating mechanisms. Jul 24, 2023 · The abdominal arteries arise from the abdominal aorta and are comprised of three groups of arteries: unpaired visceral arteries, paired visceral arteries, and parietal arteries. Aug 4, 2025 · Learn about the main arteries of the thorax and abdomen, including the carotid, subclavian, aortic, and iliac arteries, from the Supreme Vascular and Interventional Clinic in Singapore, a specialized vascular clinic in Singapore. The abdominal aorta, a continuation of the thoracic aorta, gives rise to branches such as the celiac trunk, superior mesenteric artery, and inferior mesenteric artery. In addition, the concepts of repair versus ligation, staged laparotomy, and the abdominal compartment syndrome are discussed. The majority of these injuries (67%) resulted from penetrating trauma in young men between 21 and 30 years of age. The abdominal vasculature diagram includes key structures such as the abdominal aorta, celiac trunk, splenic artery, and mesenteric arteries. Feb 16, 2024 · Abdominal vascular insults are among the most lethal injuries caused by penetrating trauma. Thirty-day outcomes included incidence and timing of VTE (in-hospital and post-discharge Trauma, 7th Ed. The term abdominal vascular injury, however, is generally reserved for injury to one of the major (named Jul 22, 2017 · Management of major vascular bleeding in the abdomen poses significantly different challenges in the resource-limited combat environment. ” The This study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma based on a large registry of trauma patients. Visceral arterial injuries account for a small but important portion of major abdominal vascular trauma. Abstract Acute vascular emergencies can arise from direct traumatic injury to the vessel or be spontaneous (non-traumatic). The term abdominal vascular or vessel injury generally refers to injury to major intraperitoneal or retroperitoneal vessels and is classified into four zones described as follows and in Table 38-1: The vascular anatomy of the abdomen includes major arteries and veins essential for supplying blood to the abdominal organs. J Trauma Feliciano et al. May 4, 2024 · Blood Supply and Lymphatics Arterial Blood Supply to the Abdomen The abdominal arteries arise from the abdominal aorta, which enters the abdomen through the diaphragmatic aortic hiatus near the T12 vertebrae and descends on the IVC’s left side anterior to the vertebral bodies (see Image. Most major abdominal vascular injuries are caused by penetrating injuries. Jun 2, 2024 · Starting with the arterial anatomy, we can trace the abdominal aorta to its first major branch – the coeliac axis (CA). Because of this low incidence, atypical symptoms, and frequent In general, vascular variations are the product of failed vascular regression, resulting in a new atypical anatomy [7]. D. It is anticipated that plasma levels would increase after major surgery and that such elevations may facilitate tumor growth. While there are clear recommendations for perioperative and post-discharge VTE chemoprophylaxis in general surgery, guidance for vascular patients is unclear. This information is intended for medical education, and does not create any doctor-patient relationship, and should not be used as a substitute for professional diagnosis and treatment. Draping is important because you will need to Preoperative exercise therapy might be effective in improving the physical fitness of patients prior to major abdominal surgery, and preoperative chest physiotherapy seems effective in reducing pulmonary complications. You will be assessing the area over the abdominal aorta, renal arteries, iliac arteries, and femoral arteries (Figure 12. The purpose of this study was to determine the role of recombinant activated factor VII (rFVIIa) in abdominal, vascular, and urological surgery. If an operation can be performed soon after injury, survival with most major abdominal arterial injuries ranges from 35% to 85%. The type of clinical presentation varies widely and depends on the presence of retroperitoneal tamponade. Once compression on the bleeding site is released, an isolated suprarenal perforation can be grabbed with a vascular forceps or long A In patients with abdominal trauma who require laparotomy, up to a quarter or a third will have a vascular injury. The distribution by injury site and respective m … Forty-four patients had more than one major vascular injury and 17 (39%) recovered, compared to a survival rate of 76% with single vascular trauma. The vascular injuries can also be divided into two categories: arteial injury and venous injury. “Vascular” is a medical term that refers to vessels. Upon admission 72% of th … The arterial supply of the abdominal wall stems from the aorta, the subclavian artery, the common iliac and external iliac arteries, and the femoral artery. This chapter aims to delineate the latest evidence-based management, treatment, and interventions to use in Jan 6, 2022 · Abdominal vasculature demonstrates extensive variability, and accurate preoperative evaluation of hepatic, renal, and pancreatic vascular anatomy is mandatory to reduce the risk of complications an In major abdominal vascular injuries, most patients present with severe hypotension, leaving very little time for diagnostic tests. ) This page includes the following topics and synonyms: Vascular Anatomy of the Abdomen, Abdominal Vascular Anatomy, Abdominal Vessel, Abdominal Artery, Abdominal Vein. 12. Most of such variant vascular anatomy is incidentally depicted at CT, MR angiography, or conventional angiography. 5 Quick bed-side ultrasound is useful as it can show intra-abdominal fluid. However consensus on training method is lacking. Major abdominal vascular injuries are noted in 5%–10% of patients undergoing laparotomy for blunt trauma. Information provided by Cardiothoracic and Vascular Surgeons in Central Texas. One of its major branches is the celiac trunk which arises from the abdominal aorta at the level of the vertebra T12. Jan 27, 2025 · Abstract Background: Venous thromboembolism (VTE) is a significant morbidity following major open abdominal surgery. Feb 15, 2022 · The Society for Vascular Surgery and the Enhanced Recovery After Surgery Society formally collaborated and elected an international, multidisciplinary panel of experts to review the literature and provide evidence-based recommendations related to all the health care received in the perioperative period for patients undergoing open abdominal aortic operations (both transabdominal and What Else Should I Know About Sonography Abdominal Vascular Assessment, Protocols, and Interpretation? The abdominal aorta, the largest artery in your body, is often evaluated using ultrasound technology. Dec 29, 2024 · Auscultation of vascular bruits in the abdomen is a non-invasive diagnostic tool used by doctors to detect abnormal blood flow in major arteries. Since 1973, 93 patients have been treated at our institution for 147 abdominal vascular injuries. There were significant preoperative differences between cohorts that were corrected using 1:1 propensity matching and logistic regression. Laparoscopic and robotic-assisted surgeries have increased in use and are associated with intra-abdominal vascular injuries at a rate as low as 0. Damage control surgery was subsequently introduced to address this “lethal triad. Your aorta is the main blood vessel through which oxygen and nutrients travel from the heart to organs throughout your body. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. is will give the surgeon proximal vascular control, at least. CT scan of abdomen can be obtained in haemodynamically stable patients with blunt trauma. Advances in prehospital emergency care have increased the numbers of patients arriving at the hospital with immediate life-threatening trauma. Historically, they occurred during large, open intra-abdominal operations performed by non-vascular specialists. While the standard diameter for this artery is about 2 centimeters, some discrepancies can occur. Patients have moderate hypotension if contained hematomas are present and present in extremis with massive abdominal distension, if hemorrhage into the peritoneal cavity is occurring. Nov 3, 2023 · There are 10 major branches of the abdominal aorta. A case of proximal superior mesenteric artery trauma is presented. By listening with a stethoscope, doctors can identify a “bruit,” a sound caused by turbulent blood flow, which may indicate underlying vascular conditions. Abdominal Aortogram — Vascular Anatomy in Action! 💉 A stunning Digital Subtraction Angiography (DSA) image beautifully outlining the major arterial branches of the abdominal aorta, captured with crystal-clear vascular detail — a true visual delight for radiology learners and vascular enthusiasts! 🔥 💡 Key Highlighted Arteries: 🔸 Abdominal Aorta — the main highway of arterial Sep 1, 2016 · Abdominal arteries can range from small, inconsequential branches to major trunks that, when injured, can commonly determine whether life or death results after penetrating trauma. Our pack includes: Tiburon® Laparotomy Drape 29410; 25 1/2" x 26" absorbent reinforcement; 4" x 12" fenestration with adhesive; instrument pad; gusseted armboard covers; cord-holding tabs (A29410N) Astound® scrub nurse gown with prewashed cloth towel in outer wrap, unreinforced, large (A90970N) Mayo stand cover, reinforced poly, 23"W (A8337CN) 10 lap sponges (CS001) Nonconductive suction Abdominal vasculature can be evaluated non-invasively using 2-D ultrasound imaging and Doppler ultrasonography. The superior epigastric vessels and musculophrenic branches comprise the bulk of the anterolateral abdominal wall vasculature. Houston, Tex. Dec 11, 2023 · Major arteries and veins: The abdominal vasculature contains many arteries and veins that branch from the aorta and vena cava and supply and drain blood from various abdominal organs. Mar 20, 2015 · EPIDEMIOLOGY All patients sustaining either blunt or penetrating abdominal trauma are at risk for hemorrhage from multiple sites, including the viscera (especially from blunt trauma), the mesentery (from blunt or penetrating trauma), or blood vessels (especially from penetrating trauma). In light of these ongoing developments, we reviewed our contemporary experience with IAVI in an attempt to clarify and refine our management strategies and the outcome of these patients. We can sort them by what part of the abdomen and pelvis they supply into visceral (organs), parietal (abdominal walls) and terminal branches. Approach to major abdominal vascular injury David V. The unpaired visceral arteries supply the gastrointestinal (GI) tract, spleen, pancreas, gallbladder, and liver and are made up of the celiac trunk, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA Abdominal vascular injuries have overall mortality rates ranging from 20–60%. Vascular endothelial growth factor (VEGF) is a potent inducer of angiogenesis that is necessary for wound healing and also promotes tumor growth. In contrast, injuries to named abdominal vessels are present in 20%–25% of patients undergoing laparotomy after gunshot wounds and in 10% after Thirty years ago we reported our experience with abdominal vascular trauma, highlighting the critical role of hypothermia, acidosis, and coagulopathy. The most commonly injured abdominal vessels are the aorta, superior mesenteric artery (SMA), iliac arteries, inferior vena cava (IVC), portal vein (PV), and iliac veins. Apr 7, 2020 · Find Major Arteries Abdominal Vascular Anatomy Abdominal stock images in HD and millions of other royalty-free stock photos, 3D objects, illustrations and vectors in the Shutterstock collection. Each common iliac artery divides into the external and internal iliac arteries. J Surg Res. For a better estimation and treatment of the injuries, the abdomen was conventionally divided into three zones as follows (10): Abdominal vascular syndromes can be divided in two major groups, according to their origin (12): congenital or compressive. This is a review of our recent 6-year experience with 161 major abdominal vascular injuries in 123 patients. Jan 1, 2015 · The abdominal major vascular injuries are usually caused by penetrating abdominal traumas, gunshot wounds, or stab wounds. The present study examined recent national trends in the development of MI and CAR after major abdominal operations. ) Duodenal Injuries (1° author: Ajai Malhotra, M. Abdominal Vascular Injury Christopher J. Vascular injuries are found in 10–20 % of patients undergoing laparotomy for penetrating injury. The impact of arterial, venous and mixed vascular injuries on patients’ outcome was of Abstract Abdominal vascular injuries account for 25% to 30% of all vascular injuries seen in urban trauma centers where penetrating wounds are the most common cause of trauma. The abdominal portion of the aorta supplies most of the abdomen, and begins at the level of the twelfth thoracic vertebra (T12), and then terminates at L4 by bifurcating into the left and right common iliac arteries. May 10, 2016 · Identification of vascular injuries in the setting of blunt abdominal trauma can pose a diagnostic challenge, as detection is reliant on appropriate multidetector computed tomography (CT) scanning protocols and familiarity with the various imaging presentations of vessel injury. We randomly assigned patients at increased risk for perioperative cardiac complications and clini Aug 1, 1982 · Major Abdominal Vascular Trauma—A Unified Approach MOORE, JOHN B. 1982-08-01 00:00:00 Advances in prehospital emergency care have increased the numbers of patients arriving at the hospital with immediate life-threatening trauma. Many patients with major abdominal vascular injuries die at the scene. Frequently, these patients reach the hospital in severe hypovolaemic shock and exsanguination accounts for their high mortality. 2–0. Blunt injuries to major abdominal vessels are rare. Congenital syndromes include several types of low-flow or high-flow vascular malformations, which can result in hemorrhagic complications. The aorta gives off the renal arteries and the 3 major trunks supplying the We would like to show you a description here but the site won’t allow us. Figure 2. Deployed settings for surgical care vary widely, and the surgeon must be prepared to tackle major abdominal bleeding with few We would like to show you a description here but the site won’t allow us. This guide dives deep into what abdominal bruits are, why they occur, and their Dec 30, 2004 · The benefit of coronary-artery revascularization before elective major vascular surgery is unclear. 16 One retrospective single-center study of penetrating abdominal vascular trauma from 1993–1998 demonstrated in-hospital mortality rates of 67% and 30% for IVC and iliac vein injuries, respectively. The clinical presentation will depend on the injured vessel, the size and type of injury, intraperitoneal or retroperitoneal location, polytrauma, and time since injury. Labeling these structures is essential for understanding their relationships and functions in the circulatory system. 2012; 177: 320-325. The major sites of hemorrhage in patients sustaining blunt or penetrating abdominal trauma are the viscera, the mesentery, and the major abdominal vessels. Treatment of vascular injury following We have studied the severity and duration of nocturnal hypoxaemia before operation and for the first five nights after operation after elective major abdominal vascular surgery. We would like to show you a description here but the site won’t allow us. Jan 16, 2024 · The abdominal aorta and its branches supply the organs of the abdomen with oxygenated blood. We conducted meta-analyses of case series and placebo-controlled studies reporting on the treatment or Find Abdominal Vascular Anatomy stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. This article reviews the cause, diagnosis, and treatment of major abdominal vascular injuries, with an emphasis on exposures and techniques of repair. From there, it travels downward, supplying oxygenated blood to major organs. The advantages and drawbacks of the surgical approaches to these injuries are discussed. Detailed knowledge of the operative approach to the aorta, iliac vessels, and visceral branches is required if Treatment of major abdominal vascular injuries is a challenge. Jul 7, 2016 · EPIDEMIOLOGY All patients sustaining either blunt or penetrating abdominal trauma are at risk for hemorrhage from multiple sites, including the viscera (especially from blunt trauma), the mesentery (from blunt or penetrating trauma), or blood vessels (especially from penetrating trauma). The blunt abdominal trauma may also cause major vascular injuries by rapid deceleration mechanism, direct anteroposterior crushing, or direct laceration. The term abdominal vascular injury, however, is generally reserved for injury to one of the major (named Two populations of open major abdominal surgery were compared in the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2021: vascular and general. This surgery is called abdominal vascular surgery. The term abdominal vascular injury generally refers to injury to major intraperitoneal or retroperitoneal vessels and is generally classified Stenotic atherosclerotic lesions in the abdominal aorta or its major branches incidentally detected on abdominal CT are relatively prevalent and carry high risk for asymptomatic coronary arterial disease. Feb 19, 2018 · Surgical Anatomy The major sites of hemorrhage in patients, victims from blunt or penetrating abdominal trauma, are the viscera, following the mesentery, and the major abdominal vessels (9). At the lower end of the abdominal aorta, it splits into two terminal branches that carry blood to the lower extremities. Apr 1, 2018 · Intra-abdominal vascular injury (IAVI) is uncommon but continues to be associated with high mortality rates despite technological advances in the past decades. It is lined by a protective membrane called the peritoneum and houses organs such as the stomach, liver, pancreas, spleen, kidneys, intestines, and various blood vessels and nerves. During embryonic development, the descending aorta is established through the fusion of the two embryonic dorsal aortae located caudal to the pharyngeal arches. Feliciano The major sites of hemorrhage in patients sustaining blunt or penetrating abdominal trauma are the viscera, the mesentery, and the major abdominal vessels. You may have no symptoms until the disease triggers a medical emergency. It gives off three major branches known as the left gastric, common hepatic and splenic arteries which supply the abdominal foregut, liver, gallbladder, pancreas and spleen. We compared the incidence of VTE in vascular versus general surgery cases and then investigated the timing of VTE in Jun 24, 2022 · Dear Editor: We read with great interest the recently published article by Colapkulu-Akgul et al. Two cohorts of major open abdominal surgery, vascular (open abdominal aortic aneurysm and aortoiliac reconstruction) and general, were compared in ACS-NSQIP database. Retroperitoneal Organs). Feliciano, M. The coeliac axis splits into the common hepatic artery (CHA) and the splenic artery (SA). The incidence of major abdominal veins injured in descending order includes the inferior vena cava (IVC), external iliac veins, renal veins, common Atherosclerotic lesions in the abdominal aorta or its major branches are often incidentally detected on abdominal CT. Patients with an Injuries to major abdominal vessels are most commonly encountered in urban trauma centers where penetrating wounds are a frequent cause of trauma. For more information on the major blood Nevertheless, the impact of such improvements and hospital volume on adverse cardiac ischemic events after major abdominal operations remains ill-defined. A common iliac artery occlusion caused by blunt force trauma is rare, and very few cases have been reported. It is anticipated that plasma levels would increase after major surgery and that such elevations may Abdominal vascular trauma is highly lethal. The distribution by injury site and respective mortality Abstract Background: The purpose of this study was to determine the role of recombinant activated factor VII (rFVIIa) in abdominal, vascular, and urological surgery. Nov 20, 2021 · Iatrogenic intra-abdominal vascular injuries remain thankfully rare. 5/1000 cases [2]. Mortality from abdominal vascular injuries in modern series remains high at 20–60%, with early deaths due to Mar 8, 2023 · Abdominal trauma that results in vascular injuries is associated with high mortality rates. Apr 14, 2025 · The abdominal aorta begins after the aorta passes through a muscle called the diaphragm, at the level of the twelfth thoracic vertebra (a spot in the upper abdomen). On the basis of a review of the literature describing the management of these injuries, ligation of the proximal superior mesenteric Blunt abdominopelvic trauma remains one of the leading causes of morbidity and mortality nationwide. Delays in diagnosis can be catastrophic, underscoring the crucial importance of prompt injury detection. Major injuries to large vessels in the abdominal zone 1 usually cause significant hemoperitoneum and shock. 1,2 When blunt trauma is the indication for laparotomy, abdominal vascular Major Abdominal Vascular Trauma (1° author: David Feliciano, M. 11). [1] entitled, “Perioperative short term prophylaxis against deep vein thrombosis after major abdominal cancer surgery: a retrospective cohort study,” the authors assessed the safety of standard postoperative pharmacological prophylaxis for deep venous thrombosis (DVT) after major oncological Oct 8, 2020 · Find Major Arteries Abdominal Vascular Anatomy Abdominal stock images in HD and millions of other royalty-free stock photos, 3D objects, illustrations and vectors in the Shutterstock collection. The venous structures mainly injured are the vena cava (29%) and the iliac veins (20%), and arterial vessels are the iliac arteries We would like to show you a description here but the site won’t allow us. Future research should focus on … Jul 1, 2018 · Atherosclerotic lesions in the abdominal aorta or its major branches are often incidentally detected on abdominal CT. Jul 22, 2024 · The abdominal cavity is the largest hollow space in the human body, containing many vital organs involved in digestion, excretion, and other essential functions. Oxygen supplementation was almost 100% effective in keeping oxygen saturation greater than 90% during the early postoperat … If major abdominal or pelvic trauma is suspected, peripheral and central lines should be placed above the diaphragm, in the subclavian or internal jugular veins. CHAPTER 34. j1 vbb 9c4n 2l6e0e tagxe wtpl ts 32uxhmd ed6n9 0s