Our experience with the surgical management of the complications of thromboembolic disease has led us to make the following recommendations: 1. 1. Inferior vena caval interruption should be carried out prior to right heart failure in all patients with failure of the usual medical management of pulmonary embolus. 2. 2. Pulmonary angiography should be performed on all patients considered for emergency pulmonary embolectomy for massive pulmonary embolus when hypotension persists in the face of adequate vasopressor therapy. 3. 3. Cardiopulmonary bypass can be utilized prior to the diagnostic studies, if needed, and should always be used prior to the administration of an anesthetic for definitive pulmonary embolectomy.