Venous congestion assessment with Venous Excess Ultrasound (VExUS) protocol: A scoping review with a focus on geriatric patients

The Venous Excess Ultrasound (VExUS) protocol has recently gained popularity for bedside assessment of venous congestion. Older frail multimorbid patients with multifactorial causes of venous congestion may theoretically benefit from this protocol. However, its diffusion across different care settings remains uncertain. We conducted a scoping review of studies with original data using peer-reviewed databases (MEDLINE, Scopus), to map the areas of application of VExUS up to November 2025. Data were extracted following a standardized approach and categorized by clinical setting (inpatient vs outpatient, ward type and specialty). Study design, sample size, mean age of participants, indications, outcomes and key findings were collected for each eligible study. We found that VExUS was frequently used in Intensive Care (37 studies out of 65 included in the review), but not in Internal Medicine (6 studies) or Geriatrics (0 studies)wards. The mean age of participants was >65 years old in only 22 studies. The most frequent indications for VExUS were congestive heart failure, cardiothoracic surgery monitoring and acute kidney injury. Study designs were exploratory in many cases and the assessed outcomes were very heterogeneous, with inconclusive findings on prognostic performance and clinical effectiveness. In conclusion, VExUS represents a feasible and potentially useful method of estimating venous congestion in critically-ill patients, while the evidence in acute geriatric patients remains scarce. Studies assessing feasibility, reliability, diagnostic and prognostic value of VExUS in older patients should be pursued in the near future, before this ultrasound protocol can be implemented into clinical practice.