Usually without. I feel like my CVOR staff are always caught off guard and have no idea where to find it when I ask for it. But honestly whatever gets the job done.
But certainly a good point on the fatness potentially making the femoral line a challenge. I think the key here though is knowing your "safe landing" before you start. Which I think is a key point for us to learn as trainees, regardless of how big or small the procedure is. Before you start out you should know what Plan B through E are.