VExUS grade (venous excess ultrasound)
Grades systemic venous congestion from bedside ultrasound: the VExUS grade, 0 to 3, read from the maximal IVC diameter plus the Doppler waveform in the hepatic, portal and intrarenal veins.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Maximal IVC diameter
- 2.4 cm
- Hepatic vein Doppler
- Severely abnormal
- Portal vein Doppler
- Mildly abnormal
- Intrarenal vein Doppler
- Normal
Result: Grade 2 - a dilated IVC with one severely abnormal territory; the mild portal finding does not count
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What the result means
- Grade 0
- IVC under 2 cm. No significant systemic venous congestion by this system, and the grading stops there.
- Grade 1
- A dilated IVC with no severely abnormal waveform. IVC dilatation alone was 41% specific in the derivation and is not sufficient to call congestion.
- Grade 2
- Moderate congestion: a dilated IVC with one severely abnormal territory.
- Grade 3
- Severe congestion: a dilated IVC with two or more severely abnormal territories. Associated with subsequent acute kidney injury after cardiac surgery, hazard ratio 3.69.
- Severe, hepatic vein
- The systolic component is reversed, toward the heart.
- Severe, portal vein
- Velocity varies by 50% or more over the cardiac cycle.
- Severe, intrarenal vein
- Discontinuous, with only a diastolic phase.
- Mild findings
- Do not raise this grade. The prototype that counted them performed worse than the one that did not; mild waveforms are a reason to look again, not a higher number.
- What it is not
- Derived in 145 adults after cardiac surgery to predict acute kidney injury. Not a volume-status meter, and Grade 3 is specific rather than sensitive, so a low grade is not evidence against congestion.
What you enter
- Maximal IVC diameter
- Hepatic vein Doppler
- Portal vein Doppler
- Intrarenal vein Doppler
How this is calculated
Beaubien-Souligny W, Rola P, Haycock K, et al. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. Ultrasound J. 2020;12(1):16. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.