VEXUS ULTRASOUND IN POSTOPERATIVE PERIOD OF MAJOR ABDOMINAL SURGERY: A SYSTEMATIC REVIEW ON THE MANAGEMENT OF VENOUS CONGESTION AND PREVENTION OF KIDNEY INJURY

Resumo

Background: Postoperative acute kidney injury (AKI) is a condition that is observed in an estimated 16% of patients who undergo major surgeries of abdomen and is linked to a six-fold risk of short-term death (Tang et al., 2025). An independent factor has been found in venous congestion that is a high central venous pressure that is retrograde to the splanchnic and renal venous beds (Damman et al., 2009; Mullens et al., 2009). The traditional methods of monitoring like cumulative fluid balance and central venous pressure (CVP) offer a partial evaluation of end-organ venous congestion (Messina et al., 2025). The Venous Excess Ultrasound (VExUS) protocol is a point of care ultrasound (POCUS) protocol combining inferior vena cava (IVC) diameter with Doppler waveforms of hepatic, portal and intrarenal veins to semi-quantitatively grade systemic venous congestion (Beaubien-Souligny et al., 2020).  To conduct a systematic literature search on the usefulness of VExUS during the postoperative phase of major abdominal surgery to identify the presence of venous congestion, predictive of AKI and to inform fluid management. Methods: A systematic review was done following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (Page et al., 2021). PubMed, Embase, Scopus, the Cochrane Library and Web of Science were searched between the onset and May 2026. The inclusion criteria were studies that reported assessment of VExUS in patients who are undergoing major abdominal surgery and have postoperative renal outcomes. Newcastle-Ottawa Scale, ROBINS-I or Cochrane RoB2 were used to evaluate the risk of bias accordingly. Since expected heterogeneity, a random-effects meta-analysis would be conducted where possible; in other cases, narrative synthesis was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to determine the certainty of evidence. Results: The review comprised of a total of 10 studies with a representative sample of surgical populations. Evidence of VExUS in major abdominal surgery is very scanty. In cardiac surgery populations, higher VExUS grades (≥2) were associated with an increased incidence of AKI (hazard ratio 3.69, 95% CI 1.65–8.24; OR 3.86, 95% CI 2.32–6.42) (Beaubien-Souligny et al., 2020; Melo et al., 2025). The incidence of postoperative venous congestion in noncardiac surgery sites was 16 to 49 percent (Andrei et al., 2023; Magin et al., 2023); the relationship with AKI is yet to be statistically significant. The assessment of severe venous congestion (combined arterial and venous Doppler) during laparoscopic urologic surgery showed that it was an independent predictor of complications (HR 8.12, 95% CI 3.5418.00, p < 0.001) (Brusasco et al., 2023). Conclusion: VExUS is a physiologically-based, non-invasive bedside instrument that has been shown to be useful in grading venous congestion in surgical patients. Nevertheless, there is limited direct data on its use in large-scale abdominal surgery, in particular, in terms of predicting AKI and fluid management. Before VExUS-guided management protocols can be suggested as standard of care, high-quality multicentric prospective studies in abdominal surgical cohorts have to be conducted.