This review of 11 cases of seat-belt associated blunt abdominal aortic trauma, includes nine cases reported in the literature and two new cases. Lap-type seat belts were the cause of this injury in eight of the 11 patients (73%). Clinical presentation was acute in 73% of the cases, with symptoms of acute arterial insufficiency, or an acute abdomen or neurologic deficits. Chronic manifestations, such as, persistent abdominal pain, claudication, abdominal mass with a bruit and decreased distal pulses, presented as late as nine months after the injury occurred. The mechanism producing the injury is discussed and a classification system for the different types of abdominal aortic injuries is put forth. Circumferential intimal disruption was the most common aortic defect. The majority of these were located distal to the inferior mesenteric artery. Diagnosis involves a high degree of suspicion in a victim wearing a seat belt with neurologic deficits, signs of acute arterial insufficiency, or a pulsatile abdominal mass. The mortality rate was 18% (2/11 patients), and occurred in patients wearing lap belts. Overall outcome depends on prompt recognition followed by appropriate surgical intervention.