Complete abdominal aortic occlusion following seat-belt trauma: a proposal for early recognition

Post-traumatic abdominal aortic occlusion (PTAO) is an extremely rare but potentially fatal consequence of high-energy blunt trauma, particularly in the setting of seat-belt injury. While thoracic aortic injuries are more commonly reported, complete occlusion of the abdominal aorta remains poorly documented, with only a few case reports available in the literature. We present two cases of seat-belt-associated PTAO, both evaluated with contrast-enhanced computed tomography (CECT), highlighting the importance of early recognition and tailored imaging protocols in polytrauma scenarios. In both cases, the aortic injury was located at the level of L3, anatomically aligned with vertebral fractures, supporting a direct traumatic mechanism. One patient underwent emergent surgical repair but succumbed to complications, while the other was successfully treated with an endovascular approach and remained stable at one-year follow-up. Key diagnostic features included sudden absence of aortic opacification, absence of vascular calcifications, and lack of collateral circulation, helping distinguish acute PTAO from chronic conditions such as Leriche syndrome. Our findings emphasize the need for radiologists and emergency clinicians to maintain a high index of suspicion for PTAO in patients with seat-belt injuries and vertebral fractures. Prompt diagnosis using CECT can guide urgent therapeutic decisions and improve patient outcomes. This report adds to the limited literature on abdominal aortic injury following blunt trauma and proposes practical imaging criteria for early detection.