Venous congestion in surgical patients assessed by the Venous Excess Ultrasound Grading System (VExUS): A comprehensive review
VExUS in surgical patients: A comprehensive review
DOI:
https://doi.org/10.54205/ccc.v34.276334Keywords:
Ultrasonography, Doppler, Hemodynamics, Acute kidney injury, Postoperative complicationsAbstract
Venous congestion from fluid overload is an underrecognized contributor to postoperative organ dysfunction. The Venous Excess Ultrasound Grading System (VExUS) is a non-invasive Doppler-based tool for assessing systemic venous congestion at the bedside. This review outlines the physiological basis, step-by-step protocol, and current clinical evidence for VExUS use in surgical patients. While it shows potential for guiding fluid management, results across studies are mixed, and several clinical limitations affect interpretation. VExUS is feasible and promising, but further multicenter research is needed to establish its clinical value and integration into perioperative care.
Downloads
References
Anders W, Bøhling B. Fluid therapy in the perioperative setting—a clinical review. J Intensive Care. 2016;4:27.
Pfortmueller CA, Dabrowski W, Malbrain MLNG. Fluid de-resuscitation in critical illness—a journey into uncertain territory. J Crit Care. 2023;76:154249.
Beaubien-Souligny W, Benkreira A, Robillard P, Bouabdallaoui N, Chassé M, Desjardins G, et al. Alterations in portal vein flow and intrarenal venous flow are associated with acute kidney injury after cardiac surgery: a prospective observational cohort study. J Am Heart Assoc. 2018;7(19):e009961.
Andrei S, Bahr PA, Nguyen M, Bouhemad B, Guinot PG. Prevalence of systemic venous congestion assessed by Venous Excess Ultrasound Grading System (VExUS) and association with acute kidney injury in a general ICU cohort: a prospective multicentric study. Crit Care. 2023;27:224.
Magin JC, Wrobel JR, An X, Acton J, Doyal A, Jia S, et al. Venous Excess Ultrasound (VExUS) grading to assess perioperative fluid status for noncardiac surgeries: a prospective observational pilot study. POCUS J. 2023;8(2):223–9.
Singh K, Carvalho R. Perioperative Venous Excess Ultrasound Score (VExUS) to guide decongestion in a dilated cardiomyopathy patient presenting for urgent surgery. Cureus. 2021;13(12):e20545.
Gupta A, Miralles Aguiar F, Beaubien Souligny W, Tavazzi G, et al. Utility of VExUS score in peri operative, critical care and emergency settings: a systematic review. Indian J Anaesth. 2023;67(11):980–91.
Martin KC, Longino A, Leyba K, et al. Correlation between venous excess ultrasound (VExUS) score and right atrial pressure: a pilot prospective observational study. Crit Care. 2023 May 26;27(1):205.
Gao M, Chen M, Dai G, Zhu D, Cai Y. The impact of goal directed hemodynamic therapy using VExUS guided fluid management on venous congestion in elective colorectal surgery. Acta Biochim Pol. 2024;71:12377.
Chin JC, Rola P, Tavazzi G, et al. Venous Excess Ultrasound (VExUS): mini review and practical guide for perioperative and critical care fluid management. World J Crit Care Med. 2025;14(2):101708.
Iranpour P, Lall C, Houshyar R, Helmy M, Yang A. Altered Doppler flow patterns in cirrhosis patients: an overview. Ultrasonography. 2016;35(1):29–41.
Ahluwalia P, Gupta B. Clinical utility of VExUS score for anaesthesiologists. Indian J Anaesth. 2023;67(10):941–2.
Gallix BP, Grenier N, Chaduc H, Morris-Stiff G, de Kerviler E. Pulsatility of the portal vein in heart failure. AJR Am J Roentgenol. 1995;165(1):23–9.
Schnell D, Darmon M. Intrarenal Doppler approaches in hemodynamics: impact of parenchymal disease. Crit Care. 2021;25(3):119.
Goonewardena S, Heffernan KS, Southworth C, et al. Doppler evaluation of hepatic venous flow in tricuspid regurgitation. JACC Cardiovasc Imaging. 2019;12(6):1000–1001.
Beaubien-Souligny W, Rola P, Haycock K, Bouchard J, Lamarche Y, Spiegel R, et al. Quantifying systemic congestion with point-of-care ultrasound: development of the venous excess ultrasound grading system. Ultrasound J. 2020;12(1):16.
Scheinfeld MH, Bilali A, Koenigsberg M. Understanding the spectral Doppler waveform of the hepatic veins in health and disease. Radiographics. 2009;29(7):2081–98.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 The Thai Society of Critical Care Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
