Accesos vasculares en el paciente con obesidad: el rol del ultrasonido en la cirugía bariátrica

Abstract: Vascular access in patients with obesity represents a significant clinical challenge due to the anatomical and physiological alterations inherent to this population, increasing the need for more precise and safer strategies for catheter placement and maintenance. Current evidence, supported by international guidelines, consensus statements, and clinical studies, consistently demonstrates that the use of ultrasound (US) improves first-attempt success rates, reduces complications, and shortens procedure times when compared with traditional techniques. Furthermore, contemporary guidelines recommend its systematic use in patients with obesity, emphasizing the integration of stratification algorithms based on difficult intravenous access (DIVA) risk assessment scales and the appropriate selection of vascular devices according to treatment duration and clinical context. Altogether, these data establish ultrasound as the tool of choice for the establishment and maintenance of vascular access in patients with obesity.