{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:07:00Z","timestamp":1784531220469,"version":"3.55.0"},"reference-count":13,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Vasc Access"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Central venous stenosis (CVS) is a clinically significant complication in patients who depend on long-term hemodialysis access. While digital subtraction angiography remains the diagnostic gold standard, it is invasive, costly, and exposes patients to contrast and radiation. This study examined the diagnostic value of a simple, non-invasive, radiation-free alternative\u2014the ultrasound-guided \u201csniff test,\u201d which assesses dynamic changes in subclavian vein diameter during a forceful sniff to screen for CVS. Despite its potential advantages, the diagnostic performance of this method has not been well established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>A prospective study was conducted among 71 end-stage kidney disease (ESKD) patients scheduled for angiography. Each participant underwent a sniff test before the procedure. A reduction of more than 40% in subclavian vein diameter during sniffing was considered normal, indicating absence of stenosis. Angiographic findings were used as the reference standard. Clinical signs\u2014specifically ipsilateral arm swelling and visible chest wall veins\u2014were also evaluated for diagnostic utility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Angiography confirmed CVS in 32 patients (45.1%). The sniff test showed a strong association with stenosis (OR 20.9) and demonstrated solid diagnostic performance, with sensitivity of 84.4%, specificity of 79.5%, and an AUC of 0.82. A normal sniff test accurately excluded stenosis in the majority of patients without CVS (86.1%), whereas an abnormal result was predominantly seen among those with stenosis (77.1%). Arm swelling was also significantly associated with stenosis (OR 20.40) and showed good standalone diagnostic accuracy (sensitivity 75.0%, specificity 87.2%, AUC 0.81). Importantly, combining the sniff test with clinical assessment enhanced overall performance, achieving higher specificity (94.9%) and excellent discriminative ability (AUC 0.90).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In conclusion, the ultrasound sniff test is a promising, accessible, and accurate screening tool for CVS. Used alone or alongside clinical findings, it offers a practical method to identify patients who may benefit from confirmatory angiography\u2014particularly valuable in resource-limited or radiation-averse settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11297298251414686","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T05:20:56Z","timestamp":1770096056000},"page":"1649-1656","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Central Vein stEnosis screeNing using Ultrasound guided Sniff test: A prospective diagnostic accuracy study (C-VENUS)"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2826-744X","authenticated-orcid":false,"given":"Jeevitha","family":"Brama Kumar","sequence":"first","affiliation":[{"name":"Department of Biomedical Imaging, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasath","family":"Swaminathan","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad Zulfikrie","family":"Abas","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research, National Institutes of Health Malaysia, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kin Wong","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging, University Malaya Medical Centre, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Rafizi Hariz","family":"Ramli","sequence":"additional","affiliation":[{"name":"Vascular Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8368-5046","authenticated-orcid":false,"given":"Chye Chung","family":"Gan","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kisu.2021.11.003"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.07010618"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneph.2023.1280666"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2012.10.024"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/096721099700500514"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.4103\/ijves.ijves_5_22"},{"key":"e_1_3_3_8_2","unstructured":"Mehta HJ Gaze DC Kibel A. Hemodialysis vascular access with central venous disease [Internet]. In: Cardiac diseases - novel aspects of cardiac risk cardiorenal pathology and cardiac interventions. London UK: IntechOpen; 2021 [cited 2025 Sep 9]. 4-6p. Available from: https:\/\/www.intechopen.com\/books\/9578"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004424-198508000-00013"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1042\/cs0690091"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0214288"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2007.09.043"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/11297298241293826"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.4103\/0971-4065.202825"}],"container-title":["The Journal of Vascular Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11297298251414686","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11297298251414686","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11297298251414686","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:48:36Z","timestamp":1784530116000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11297298251414686"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":13,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/11297298251414686"],"URL":"https:\/\/doi.org\/10.1177\/11297298251414686","relation":{},"ISSN":["1129-7298","1724-6032"],"issn-type":[{"value":"1129-7298","type":"print"},{"value":"1724-6032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]}}}