Ultrasound indicators of organ venous congestion: a narrative review

Acute kidney injury and other organ dysfunction in the setting of heart failure are primarily determined by a low cardiac output status and venous congestion, which is a sequence of increases in heart filling pressures. Early point-of-care ultrasound assessment of the inferior vena cava, lung ultrasound for pulmonary congestion, and focused echocardiography have become increasingly used in the bedside evaluation of congestive heart failure and assessment of the left ventricle. The congestion disrupts venous outflow in abdominal organs, most notably the kidneys and liver, and can be noninvasively evaluated with Doppler ultrasound, known as the venous excess. Such flow abnormalities have been repeatedly linked to congestive organ dysfunction and poorer clinical outcomes. In this review, we outline a thorough, bedside approach to assessing venous congestion using Doppler imaging. Venous Excess Ultrasound (VExUS) is an emerging protocol that offers a point-of-care ultrasonic method for grading systemic congestion and tailoring diuretic management. The purpose of this review is to evaluate VExUS's potential applications and critically appraise current evidence on its effectiveness in directing decongestive therapy for patients with acute decompensated heart failure. In conclusion, multiple Doppler venous congestion assessment emerges as a promising, noninvasive tool for the instantaneous assessment of organ congestion in cardiorenal syndrome, helping in the management of fluid and diuretic administration. Its accuracy, however, depends on the sonographer's proficiency. Larger-scale studies are needed to confirm their applicability in clinical practice.