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Updated: Jan 18, 2026

Demystifying Venous Excess Ultrasound (VExUS): Image Acquisition and Interpretation
05:49

Demystifying Venous Excess Ultrasound (VExUS): Image Acquisition and Interpretation

Published on: May 16, 2025

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Applications of Venous Excess Ultrasound Score (VExUS) in Volume Status Assessment in Patients With Acute

Dina Soliman1, Chanokporn Puchongmart1, Ben Thiravetyan1

  • 1From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX.

Cardiology in Review
|January 16, 2026
PubMed

Insights

The Venous Excess Ultrasound (VExUS) score offers a noninvasive method to assess systemic congestion in heart failure and cardiorenal syndrome. VExUS aids in detecting renal congestion and guiding diuretic therapy, improving patient risk stratification and treatment.

Area of Science:

  • Cardiology
  • Nephrology
  • Medical Imaging

Background:

  • Accurate assessment of volume status and venous congestion is critical for managing congestive heart failure (CHF) and cardiorenal syndrome (CRS).
  • Traditional methods for detecting venous congestion have significant limitations.
  • The Venous Excess Ultrasound (VExUS) score provides a novel, noninvasive approach.

Purpose of the Study:

  • To review the current evidence on the utility of the VExUS score in patients with CHF and CRS.
  • To highlight the diagnostic performance, advantages, and challenges of VExUS.
  • To evaluate VExUS's role in risk stratification and treatment optimization.

Main Methods:

  • This narrative review synthesizes existing studies on the VExUS score.
  • VExUS integrates Doppler assessment of the inferior vena cava, hepatic, portal, and intrarenal veins.
  • Evidence correlating VExUS with right atrium pressure and outcomes is examined.

Main Results:

  • VExUS strongly correlates with right atrium pressure.
  • VExUS outperforms individual ultrasound or biochemical markers in predicting elevated filling pressures and acute kidney injury.
  • VExUS may detect subclinical renal congestion and guide diuretic therapy.

Conclusions:

  • VExUS is a promising, accessible tool for assessing systemic congestion in CHF and CRS.
  • It enhances risk stratification and treatment optimization.
  • Further prospective studies are needed for standardization and validation.

Keywords:
Venous Excess Ultrasoundcardiorenal syndromeheart failurepoint-of-care ultrasound

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