Venous Excess Ultrasound (VExUS) Score
Assesses venous congestion in patients with volume overload and estimates the likelihood of developing acute kidney injury, particularly in those at risk for cardiorenal syndrome.
The derivation study used the following ultrasound/Doppler techniques:
- IVC diameter: Measure inner-to-inner wall in a longitudinal subxiphoid view of the intrahepatic segment, approximately 2 cm caudal to the hepatic vein confluence, using the maximal diameter over the respiratory cycle.
- Hepatic and portal vein Doppler: Use a mid- to posterior-axillary transthoracic window.
- Intrarenal venous Doppler: Use a posterior axillary approach to obtain a longitudinal kidney view, then acquire a pulsed-wave Doppler waveform at the corticomedullary junction.
- Obtain a concurrent ECG tracing to identify phases of the cardiac cycle.
See Beaubien-Souligny et al. (2018) for additional detail.
Advice
- Results from this tool may be incorporated into a patient’s overall clinical picture to guide diuresis or predict the development of postoperative AKI.
- Apply in patients who meet the original study criteria; use caution in patients with:
- Tricuspid regurgitation.
- Mechanical ventilation.
- Ventricular assist devices or mechanical circulatory support.
- Reliability may be reduced in patients with chronic kidney disease (eGFR <15 mL/min/1.73m2) or renal transplant.
- Studies recommend serial evaluations, often at 24- to 72-hour intervals.
Management
- Grade ≥2: Consider diuretics for venous decongestion.
- Grade 0–1: Patients may still benefit from diuresis; guide therapy based on the clinical context, physical exam, and laboratory evaluation.
Critical Actions
Do not delay time-sensitive, life-saving therapies in unstable patients to perform this exam.