Integrated Bedside Hemodynamic Assessment and Monitoring of Venous Congestion With Venous Excess Ultrasound (VExUS): A Narrative Review.

This review evaluates the venous excess ultrasound (VExUS) score as a bedside tool for quantifying systemic venous congestion and predicting congestive end-organ injury, particularly acute kidney injury (AKI). By assessing flow patterns in the hepatic, portal, and renal veins alongside inferior vena cava (IVC) size, VExUS enables serial monitoring of congestion trajectories. While highly prognostic in heart failure, its predictive performance varies in more heterogeneous populations. Ultimately, integrating VExUS with cardiac output indices may help clinicians identify specific hemodynamic phenotypes, guiding targeted, individualized therapeutic strategies.