Diagnosis and hybrid interventional and surgical removal of ectopic heartworms (Dirofilaria immitis) in a dog

An adult male castrated French bulldog mix was presented for suspected caval syndrome and bilateral pelvic limb paresis. After emergency transjugular heartworm extraction, abdominal ultrasound revealed occlusive adult heartworms in the abdominal aorta extending into the pelvic limb arteries. Hybrid interventional and surgical extraction was pursued, and heartworms were removed via bilateral femoral arteriotomy and caudal abdominal aortotomy. Ectopic dirofilariasis involving the aorta and pelvic limb arteries is rarely reported; therefore, the underlying mechanism, incidence, and treatment of aberrant heartworms are poorly understood. This case report describes a unique hybrid approach involving heartworm extraction via femoral arteriotomy interventionally and aortotomy surgically.