Endocrine Abstracts

Women with Turner Syndrome (TS) are at significantly increased risk of aortic dilation and dissection. However, predicting the risk of aortic dissection (AoD) is difficult with many women attending annual appointments with time, travel and parking costs and resource implications. We developed a risk-based pathway based on the international guidelines, enabling closer follow up for those with a greater risk and reduce the frequency of appointments for those at the least risk.

Methods: Women with TS (n=168) were divided into 2 pathways depending on risk factors for AoD, and subsequently split into 4 groups depending on aortic size index (ASI). The pathway then determined frequency of review and imaging. The main differences from the current international guidelines being that those with an ASI <2.0cm/m² and no risk factors are followed up by the endocrinology team and those with an ASI ≥2.5cm/m² are referred directly to the aortic MDT.

Results: Over a 2-year prospective analysis, no patient changed pathway. Of the 11 patients in the highest risk groups: 7 had ascending aorta replacements, 1 is awaiting surgery, 1 had a low BMI therefore making her aorta proportionally larger, 1 had previously dissected her aorta whilst waiting surgery and 1 declined surgery. Following the implementation of our pathway, cardiology outpatient appointments have reduced from 168 to 93, saving 75 appointments and the trust nearly £8000 a year. There has been no increase in ‘did not attend’ appointments.

Conclusion: A risk-stratified streamlined aortic monitoring pathway safely allowed consolidation of resources to women perceived to be at the highest risk of AoD (excluding pregnancy), enabling diversion of resources to those most at risk of AoD and reducing travel and attendance times for patients.