Venous congestion in surgical patients assessed by the Venous Excess Ultrasound Grading System (VExUS): A comprehensive review

Venous congestion from fluid overload is an underrecognized contributor to postoperative organ dysfunction. The Venous Excess Ultrasound Grading System (VExUS) is a non-invasive Doppler-based tool for assessing systemic venous congestion at the bedside. This review outlines the physiological basis, step-by-step protocol, and current clinical evidence for VExUS use in surgical patients. While it shows potential for guiding fluid management, results across studies are mixed, and several clinical limitations affect interpretation. VExUS is feasible and promising, but further multicenter research is needed to establish its clinical value and integration into perioperative care.