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The VExUS Simulator is best experienced in Landscape Mode.

HEPATIC VEIN Normal (S > D)
PVC (CVP) Waves a-c-v / x-y
PORTAL VEIN Normal (< 30%)
INTERLOBAR RENAL VEIN Normal (Continuous) | IR: 0.65
ECG (Lead II)

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The VExUS Score : Fundamentals & Pathophysiology

Definition

VExUS (Venous Excess UltraSound) is a multiparametric ultrasound score designed to quantify systemic congestion beyond simple Inferior Vena Cava (IVC) diameter measurement.

Mechanism

It's thought that when maximum venous capacitance is reached, venous pressure rises sharply. This pressure transmits cardiac cycle waves backward into the splanchnic veins to the hepatic, portal, and renal veins.

Clinical Significance

  • Cardiac Surgery: Historically the primary field of application for predicting post-operative Acute Kidney Injury (AKI).
  • General Critical Care: Now extended to ICU patients and those with chronic heart failure to guide fluid removal.
  • The Surgical Kidney: Recent data shows a strong linear correlation between Intra-Abdominal Pressure (IAP) and the Renal Resistive Index (RRI), where RRI = 0.55 + (0.015 * IAP).

Pitfalls & Limitations

Severe TR: Severe Tricuspid Regurgitation can mimic severe congestion on Hepatic Vein doppler (S-reversal) even if the overall volume status is not the primary cause.

Both the hepatic vein and the renal vein can be affected, the only VExUS parameter that remains reliable is the portal vein in the non-cirrhotic patient.

The portal system is separated from the right heart by hepatic sinusoids, which prevent the direct transmission of cardiac waves. Therefore, portal pulsatility often better reflects true congestive states and is a superior predictor of diuretic responsiveness

Interactive Clinical Cases

Click below to load specific hemodynamic profiles into the simulator:

The "Lazy" Lateral View

Position the probe on the Right Mid-Axillary Line (standard FAST/Morison's pouch view). Keep the probe steady and use "tilting" to navigate:

  • Posterior Tilt: Towards the bed to visualize the Hepatic Veins and IVC confluence.
  • Anterior Tilt: Towards the umbilicus to find the Portal Vein.
  • Inferior/Anterior Tilt: Slide slightly down to find the Kidney and Renal Interlobar vessels.

Tweaking the System

To obtain professional-grade waveforms as seen in the simulator, adjust these parameters:

  • Doppler Gate: Set to 2-3 mm for the renal interlobar vein to avoid arterial interference.
  • Gain: Adjust until the spectral envelope is crisp without "snow" or background noise.
  • Sweep Speed: Slow down the sweep to capture at least 3-4 cardiac cycles per screen for better pattern recognition.
  • Wall Filter: Keep it low to avoid losing the end-diastolic flow information.