A closer look at aortic seat belt injuries: review of 52 cases published in the last 60 years

Authors

  • Eduardo Silva Department of Angiology and Vascular Surgery, Coimbra Hospital and University Center; Coimbra, Portugal https://orcid.org/0000-0002-5202-9070
  • Vânia Constâncio Department of Angiology and Vascular Surgery, Coimbra Hospital and University Center; Coimbra, Portugal https://orcid.org/0000-0002-4059-3520
  • Celso Nunes Department of Angiology and Vascular Surgery, Coimbra Hospital and University Center; Coimbra, Portugal https://orcid.org/0000-0001-5928-3496
  • Leonor Baldaia Department of Angiology and Vascular Surgery, Coimbra Hospital and University Center; Coimbra, Portugal https://orcid.org/0000-0001-9979-8646
  • Miguel Castro Department of Angiology and Vascular Surgery, Coimbra Hospital and University Center; Coimbra, Portugal https://orcid.org/0000-0002-6881-7514
  • Luís Orelhas Department of Angiology and Vascular Surgery, Coimbra Hospital and University Center; Coimbra, Portugal
  • Mário Moreira Department of Angiology and Vascular Surgery, Coimbra Hospital and University Center; Coimbra, Portugal
  • Manuel Fonseca Department of Angiology and Vascular Surgery, Coimbra Hospital and University Center; Coimbra, Portugal

DOI:

https://doi.org/10.48750/acv.553

Keywords:

Trauma, Seat Belt Triad, Seat Belt Aorta, Seat Belt

Abstract

INTRODUCTION: Seat belt aorta is a rare but often severe complication arising from blunt trauma with compression of the abdominal aorta against vertebrae. Seat belt sign is often present as an ecchymosis across the abdomen. The association with abdominal wall disruption and hollow viscus injury has been named seat belt triad; the presence of Chance fracture is sometimes considered a fourth component.
METHODS: Using Pubmed and Embase databases we reviewed all articles regarding abdominal seat belt aortic injuries and analysed presentation at admission, concomitant lesions, including presence of seat belt triad, treatment and outcomes.
RESULTS: Fifty-two cases were reported, from 1968 to 2019. Twenty-nine males (56%), mean age 43 ± 19 years. Most patients were stable at admission, with 29 (55.8%) presenting acute abdomen, 26 (50%) limb ischemia, 9 (17.3%) hypovolemic shock and 2 (3.8%) late-onset claudication. Seat belt sign was identified in 40 patients (76.9%), seat belt triad in 38 (73.1%) and 22 (42.3%) had Chance fractures, of which only 2 were not associated with seat belt triad. Most patients presented with aortic dissection (90.4%), complicated with pseudoaneurysm (11.5%), contained rupture (7.7%) or uncontained rupture (3.8%); 2 patients presented isolated iliac thrombosis and 3 limb ischemia. All patients required immediate surgical intervention, of which 40 (76.9%) required urgent vascular surgery. Forty-eight patients (92.3%) underwent vascular surgery: 39 open revascularizations and 9 endovascular procedures; three were managed conservatively. Ten patients (19.2%) passed away or died, of which 7 had seat belt triad. No patients needed reinterventions for vascular lesions except one, yet 3 required limb amputation. Most patients with seat belt triad required further visceral and abdominal wall repair.
CONCLUSIONS: Seat belt aorta and especially seat belt triad are severe complications associated with high morbimortality often requiring surgery and multiple interventions. As patients are usually conscious and stable upon admission, this condition should not be disregarded.

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References

Cuesta RC, Casas IM, Armenteros FJ, Argote AX, Capitan JM. Seat Belt Syndrome and the Submarine Effect: A Case Report. Chirurgia (Bucur). 2017;112: 624-6

Kulvatunyou N, Albrecht RM, Bender JS, Friese RS, Bellal J, Latafi R, et al. Seatbelt triad: severe abdominal wall disruption, hollow viscus injury, and major vascular injury. Am Surg. 2011;77: 534-8

Ahmed M, Mahmoud A, Samotowka M, Mitchell K, Saeed R. Seat Belt Aortic Dissection: A Case Report. Cureus. 2019;11:e4662

Randhawa MP Jr, Menzoian JO. Seat belt aorta. Ann Vasc Surg. 1990;4:370-7.

Freni L, Barbetta I, Mazzaccaro D, Settembrini AM, Dallatana R, Tassinari L, et al. Seat belt injuries of the abdominal aorta in adults--case report and literature review. Vasc Endovascular Surg. 2013;47:138-47

Tomic I, Dragas M, Vasin D, Loncar Z, Fatic N, Davidovic L. Seat-Belt Abdominal Aortic Injury-Treatment Modalities. Ann Vasc Surg. 2018;53:270e16

Warrian RK, Shoenut JP, Iannicello CM, Sharma GP, Trenholm BG. Seatbelt injury to the abdominal aorta. J Trauma. 1988;28:1505-7

Lalancette M, Scalabrini B, Martinet O. Seat-belt aorta: a rare injury associated with blunt abdominal trauma. Ann Vasc Surg. 2006;20:681-3

Campbell DK, Austin RF. Seat-belt injury: injury of the abdominal aorta. Radiology. 1969;92:123-4

Clyne CA, Ashbrooke EA. Seat-belt aorta: isolated abdominal aortic injury following blunt trauma. Br J Surg. 1985;72:239

Siriwardena AK. Seat-belt aortic injury. Eur J Vasc Surg. 1990;4:649-50.

Ali MR Jr, Norcross ED, Brothers TE. Iliac and femoral artery occlusion by thromboemboli from an abdominal aortic aneurysm in the setting of blunt abdominal trauma. J Vasc Surg. 1998;27:545-8

Gouveia E Melo R, Amorim P, Soares TR, Fernandes e Fernandes R, Ministro A, GarridoP, et al. Clinical aspects and present challenges of the seat belt aorta. J Vasc Surg. 2020;72:995-1004

Shweiki E, Klena JW, Halm KA, Leonard DJ. Seat belt injury to the abdominal aorta. Am J Emerg Med. 2000;18:236-7

Dunlop MG. Distal arterial emboli following seat belt injury of the aorta. Injury. 1986;17:370-1

Johnstone BR, Waxman BP. Transverse disruption of the abdominal wall--a tell-tale sign of seat belt related hollow viscus injury. Aust N Z J Surg. 1987;57:455-60

Frydenberg M, Royle JP, Hoare M. Blunt abdominal aortic trauma. Aust N Z J Surg. 1990;60:347-50

Naude GP, Back M, Perry MO, Bongard FS. Blunt disruption of the abdominal aorta: report of a case and review of the literature. J Vasc Surg. 1997;25:931-5

Gilani R, Saucedo-Crespo H, Scott BG, Tsai PI, Wall MJ Jr, Mattox KL. Endovascular therapy for overcoming challenges presented with blunt abdominal aortic injury. Vasc Endovascular Surg. 2012;46:329-31

Thal ER, Perry MO, Crighton J. Traumatic abdominal aortic occlusion. South Med J. 1971;64:653-6

Voellinger DC, Saddakni S, Melton SM, Wirthlin DJ, Jordan WD, Whitley D. Endovascular repair of a traumatic infrarenal aortic transection: a case report and review. Vasc Surg. 2001;35:385-9

Reaney SM, Parker MS, Mirvis SE, Bundschuh CV, Luebbert PD, Vingan HL. Abdominal aortic injury associated with transverse lumbar spine fracture--imaging findings. Clin Radiol. 1995;50:834-8

Danto LA, Wolf man EF Jr. Linear abdominal trauma. J Trauma. 1976;16(3):179-183.

Bergqvist D, Takolander R. Aortic occlusion following blunt trauma of the abdomen. J Trauma. 1981;21:

Crepps JT Jr, Rodriguez A. Combined abdominal aortic and visceral artery injury secondary to blunt trauma. Injury. 1989;20:319-22

Vernhet H, Marty-Ané CH, Lesnik A, et al. Dissection of the abdominal aorta in blunt trauma: management by percutaneous stent placement. Cardiovasc Intervent Radiol. 1997;20:473-6

Perry JR, Escobedo EM, Mann FA. Abdominal aortic injury associated with "seat belt syndrome". Emerg Rad. 2000;7:312-4

Inaba K, Kirkpatrick AW, Finkelstein J, Murphy J, Brenneman FD, Boulanger BR, et al. Blunt abdominal aortic trauma in association with thoracolumbar spine fractures. Injury. 2001;32:201-7

Stahlfeld KR, Mitchell J, Sherman H. Endovascular repair of blunt abdominal aortic injury: case report. J Trauma. 2004;57:638-41

Sugimoto T, Omura A, Kitade T, Takahashi H, Koyama T, Kurisu S. An abdominal aortic rupture due to seatbelt blunt injury: report of a case. Surg Today. 2007;37:86-8

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Published

2024-03-03

How to Cite

1.
Silva E, Constâncio V, Nunes C, Baldaia L, Castro M, Orelhas L, Moreira M, Fonseca M. A closer look at aortic seat belt injuries: review of 52 cases published in the last 60 years. Angiol Cir Vasc [Internet]. 2024 Mar. 3 [cited 2024 Apr. 12];19(4):221-5. Available from: https://acvjournal.com/index.php/acv/article/view/553

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Review Article

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