ToolsCalculators
Venous Excess Ultrasound (VExUS) score
Point-of-care ultrasound grading of systemic venous congestion using IVC diameter with hepatic, portal, and intra-renal Doppler.
Venous Excess Ultrasound (VExUS) score
IVC diameter
Hepatic vein Doppler
Portal vein Doppler
Intra-renal venous Doppler
ResultGrade 0
IVC <2 cm: no venous congestion.
- VExUS grade
- 0
When to use
- Quantifying systemic venous congestion at the bedside in volume overload, right heart failure, or after cardiac surgery.
- Assessing risk of congestion-associated acute kidney injury and guiding decongestive therapy.
Formula
IVC <2 cm = grade 0. If IVC >=2 cm: grade 1 if no Doppler pattern is severely abnormal, grade 2 if one of the hepatic/portal/intra-renal patterns is severely abnormal, grade 3 if two or more patterns are severely abnormal.
Pearls and pitfalls
- Grade 3 VExUS was independently associated with subsequent acute kidney injury after cardiac surgery in the derivation cohort.
- VExUS reflects venous congestion regardless of cause (volume vs. pressure overload) and should be interpreted alongside cardiac and volume-status assessment, not used alone to guide diuresis.