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Updated: Mar 1, 2026

Demystifying Venous Excess Ultrasound (VExUS): Image Acquisition and Interpretation
Published on: May 16, 2025
Venous Excess Ultrasound Score (VExUS) Association with Disease Severity in Acute Pulmonary Embolism
Francisco Javier Gimena-Rodríguez1, Paula Bermejo-Acevedo2, Paula de Peralta-García2
1Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Madrid, Spain; Venous Thromboembolic Disease Unit, Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Spain.
Objectives:
Venous Excess Ultrasound Score (VExUS) protocol has emerged as a non-invasive tool for assessing systemic congestion. Its utility in pulmonary embolism (PE) remains uncertain. This study aims to analyze VExUS findings in acute PE patients and determine their association with disease severity category.
Methods:
A prospective cohort study was conducted between May 2024 and May 2025. Patients with confirmed acute PE were included. Ultrasonographic assessment following the VExUS protocol was performed prior to or within 24h of antithrombotic therapy initiation. The primary outcome was the ordered association between PE severity and VExUS score analyzed using the Jonckheere-Terpstra test and ordinal logistic regression.
Results:
Eighty patients were evaluated (43.8% women, mean age 66.7±14.3 years), of them: 28.8% had low risk, 42.5% intermediate-low risk, 21.3% intermediate-high risk, and 7.5% high risk PE. All patients in the low and intermediate-low risk groups had a VExUS score of 0, while intermediate-high and high risk patients had progressively higher scores (Jonckheere-Terpstra's J=1020, p<0.001). The portal vein pulsatility index was identified as the parameter most precisely associated with severity (OR 1.16; 95% CI: 1.06-1.26). Hepatic vein patterns also showed a significant association (S>D vs S
Conclusions:
The assessment of venous congestion using the VExUS protocol in patients with acute PE demonstrates a direct association with risk category.
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