Massive pulmonary embolism (PE) is a severe condition that can potentially lead to death caused
by right ventricular (RV) failure and the consequent cardiogenic shock. Despite the fact thrombolysis is often
administrated to critical patients to increase pulmonary perfusion and to reduce RV afterload, surgical treatment
represents another valid option in case of failure or contraindications to thrombolytic therapy. Correct risk
stratification and multidisciplinary proactive teams are critical factors to dramatically decrease the mortality of this
global health burden. In fact, the worldwide incidence of PE is 60–70 per 100,000, with a mortality ranging from
1% for small PE to 65% for massive PE. This review provides an overview of the diagnosis and management of
this highly lethal pathology, with a focus on the surgical approaches at the state of the art
