Venous Excess Ultrasound Score (VExUS) Association with Disease Severity in Acute Pulmonary Embolism.

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<D or inverted S OR 16.57; 95% CI: 2.41-113.83). The IVC diameter and renal veins pattern did not demonstrate a significant association with PE severity.

CONCLUSIONS

The assessment of venous congestion using the VExUS protocol in patients with acute PE demonstrates a direct association with risk category.