190 Evaluating the Management of Cephalic Arch Stenosis in A North London Hospital

Aim Brachiocephalic fistulas (BCFs) are the most commonly used arteriovenous fistulas (AVFs). They are commonly associated with cephalic arch stenosis (CAS), a leading cause of dysfunction and failure. The 2018 European Society of Vascular Surgery guidelines recommend the consideration of stent grafts for managing CAS. In this study, we sought to evaluate the management of CAS in a North London hospital. Method We carried out a retrospective study of patients who had undergone a fistulogram/fistuloplasty for CAS between May 2014 and May 2020. We extracted demographic data, information about their access, and information regarding surgical management of CAS, from the patients’ records on VitalData. We extracted data about recurrence of CAS from their Cerner records. Results Seventy patients were included. 54.3% were still alive at the time of data collection. The average age of those still alive was 65.8±14.1 years. 78.6% had a left BCF. 66% had previous access. 4.29% underwent stenting for CAS. The rest had fistulopasties alone. 90% required multiple fistulopaslties (mean=3.44±1.51). Median interval between access creation and first fistuloplasty was 1.90 years. 34.3% of patients underwent surgical repair of their AVF. AVF failure rate was 34.3%. Median interval between access creation and failure was 3.05 years. Median interval between first fistuloplasty and access failure was 1.34 years. Conclusions Our data demonstrate a high rate of access failure in patients with CAS treated at our centre. Few of our patients had stent grafts inserted. The majority had fistuloplasties without stenting, which was associated with a high recurrence rate.

Gladys Mary Wauchope (1889–1966): Brighton physician and second female medical student at the London Hospital Medical College

Gladys Mary Wauchope was a pioneering woman physician and general practitioner in London and Brighton. Descended from an ancient Scottish family, she was the second female medical student at the London Hospital Medical College after Elizabeth Garrett Anderson, enrolling during the brief period from 1918 to 1928 in which women were permitted to study medicine in mainstream London medical schools due to shortages of doctors caused by the First World War. Unperturbed by opposition to her gender from male colleagues, she was initially house physician on the firm of Sir Robert Hutchison at ‘the London’, and went on to hold an array of posts in large London hospitals at a time when finding such work was challenging for women doctors. She settled in Hove as a general practitioner in 1924, later becoming a consultant physician at several major Brighton hospitals. Made only the eighth female fellow of the Royal College of Physicians, she also set up the first diabetic clinic in Sussex and Kent. Gladys authored several books, including her autobiography ‘The Story of a Woman Physician’, which documents life through two world wars and the introduction of the National Health Service, whilst keenly observing the changing landscape of medicine and its place in society.